The 3-year results of the Barrow Ruptured Aneurysm Trial (BRAT), an intention-to-treat study comparing safety and efficacy of microsurgical clip occlusion versus endovascular coil embolization for aSAH patients, were reported in J. Neurosurgery (July 2013). Secondary analyses included outcome based on actual treatment due to significant (38%) crossover from coiling to clipping arms. Posthoc analysis of anterior circulation aneurysms revealed equivalent clip vs. coil outcomes at all timepoints. At 3 year follow-up, the functional outcomes of all patients assigned to coil embolization showed a favorable 5.8% absolute difference compared with those assigned to clip occlusion, although this difference did not reach statistical significance (p = 0.25). Overall, the clip group had significantly higher aneurysm obliteration (85% vs. 52%, p= 0.0001) and significantly lower recurrence and retreatment (5% vs. 13%, p= 0.01).
Journal of Neurosurgery