BACKGROUND: Two types of treatment are being used for patients with ruptured intracranial aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative safety and efficacy of these approaches had not been established. Here we present clinical outcomes 1 year after treatment. METHODS: 2143 patients with ruptured intracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in the UK and Europe, took part in the trial. They were randomly assigned to neurosurgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome was death or dependence at 1 year (defined by a modified Rankin scale of 3-6). Secondary outcomes included rebleeding from the treated aneurysm and risk of seizures. Long-term follow up continues. Analysis was in accordance with the randomised treatment. FINDINGS: We report the 1-year outcomes for 1063 of 1073 patients allocated to endovascular treatment, and 1055 of 1070 patients allocated to neurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 patients allocated to neurosurgery, an absolute risk reduction of 7.4% (95% CI 3.6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 years and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebleeding was higher. INTERPRETATION: In patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival benefit continues for at least 7 years. The risk of late rebleeding is low, but is more common after endovascular coiling than after neurosurgical clipping.
BACKGROUND: Two types of treatment are being used for patients with ruptured intracranial aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative safety and efficacy of these approaches had not been established. Here we present clinical outcomes 1 year after treatment. METHODS: 2143 patients with ruptured intracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in the UK and Europe, took part in the trial. They were randomly assigned to neurosurgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome was death or dependence at 1 year (defined by a modified Rankin scale of 3-6). Secondary outcomes included rebleeding from the treated aneurysm and risk of seizures. Long-term follow up continues. Analysis was in accordance with the randomised treatment. FINDINGS: We report the 1-year outcomes for 1063 of 1073 patients allocated to endovascular treatment, and 1055 of 1070 patients allocated to neurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 patients allocated to neurosurgery, an absolute risk reduction of 7.4% (95% CI 3.6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 years and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebleeding was higher. INTERPRETATION: In patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival benefit continues for at least 7 years. The risk of late rebleeding is low, but is more common after endovascular coiling than after neurosurgical clipping.
Authors: Pablo Harker; Robert W Regenhardt; Naif M Alotaibi; Justin Vranic; Faith C Robertson; Adam A Dmytriw; Jerry C Ku; Matthew Koch; Christopher J Stapleton; Thabele M Leslie-Mazwi; Nelson Serna; Boris Pabon; Juan A Mejia; Aman B Patel Journal: Neuroradiology Date: 2021-05-25 Impact factor: 2.804
Authors: D J Nieuwkamp; G J E Rinkel; R Silva; P Greebe; D A Schokking; J M Ferro Journal: J Neurol Neurosurg Psychiatry Date: 2006-04-25 Impact factor: 10.154
Authors: Robert M Starke; Nohra Chalouhi; Dale Ding; Daniel M S Raper; M Sean Mckisic; Gary K Owens; David M Hasan; Ricky Medel; Aaron S Dumont Journal: Transl Stroke Res Date: 2013-10-10 Impact factor: 6.829
Authors: Robert M Starke; Daniel M S Raper; Dale Ding; Nohra Chalouhi; Gary K Owens; David M Hasan; Ricky Medel; Aaron S Dumont Journal: Transl Stroke Res Date: 2013-09-20 Impact factor: 6.829
Authors: Mario Zanaty; Nohra Chalouhi; Stavropoula I Tjoumakaris; Robert H Rosenwasser; Pascal M Jabbour Journal: Transl Stroke Res Date: 2013-11-24 Impact factor: 6.829
Authors: Byung Moon Kim; Dong Ik Kim; Eun Chul Chung; Sun Yong Kim; Yong Sam Shin; Sung Il Park; Dong Joon Kim; Sang Hyun Suh; Chun Sik Choi; Yu Sam Won Journal: Neuroradiology Date: 2007-11-10 Impact factor: 2.804