Jean Raymond1, Tim E Darsaut. 1. Department of Radiology and Interventional Neuroradiology Research Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada. jean.raymond@umontreal.ca
Abstract
BACKGROUND: Evidence regarding the most appropriate management of aneurysm recurrences following coiling consists only of uncontrolled case series and the resulting expert opinions, which range from not following coiled patients at all to performing invasive angiography at regular intervals. METHODS: We discuss several current attitudes toward how to manage post-coiling recurrences and outline an approach to finding concrete, practical answers to common clinical questions. RESULTS: Although some maxims and general statements can be reluctantly offered, in the absence of evidence the best approach is to emphasize proper methods in order to one day find reliable answers. These can only come from randomized clinical trials. The multitude of research questions is an added difficulty. A program of necessary trials is proposed and centers are encouraged to work in a collaborative fashion in order to offer best possible care as well as progress. CONCLUSION: Common clinical questions, including how to follow coiled aneurysm patients, if and when to re-treat, and with which treatment modality, are best addressed with the sound scientific methodology of clinical trials.
BACKGROUND: Evidence regarding the most appropriate management of aneurysm recurrences following coiling consists only of uncontrolled case series and the resulting expert opinions, which range from not following coiled patients at all to performing invasive angiography at regular intervals. METHODS: We discuss several current attitudes toward how to manage post-coiling recurrences and outline an approach to finding concrete, practical answers to common clinical questions. RESULTS: Although some maxims and general statements can be reluctantly offered, in the absence of evidence the best approach is to emphasize proper methods in order to one day find reliable answers. These can only come from randomized clinical trials. The multitude of research questions is an added difficulty. A program of necessary trials is proposed and centers are encouraged to work in a collaborative fashion in order to offer best possible care as well as progress. CONCLUSION: Common clinical questions, including how to follow coiled aneurysmpatients, if and when to re-treat, and with which treatment modality, are best addressed with the sound scientific methodology of clinical trials.