• International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms

    • Oct 11, 2021

    • International study to compare neurosurgical clipping versus endovascular coiling for ruptured intracranial aneurysms.
    • Multi-center, randomized, controlled trial.
    • Patients with subarachnoid hemorrhage due to ruptured aneurysms who were deemed suitable for either treatment were included. 
    • Outcome measures: Primary outcomes were death or dependence at 1 year (modified Rankin scale of 3-6). Secondary outcomes were rebleeding, and risk of seizures.
    • Endovascular coiling group: 1073 patients, 1063 included in 1-year analysis, 23.5% dead or dependent. 
    • Neurosurgical clipping group: 1070 patients, 1055 included in 1-year analysis, 30.9% dead or dependent. 
    • Survival benefit for coiling was maintained for at least 7 years and was statistically significant (p=0.03).
    • Risk of seizures was significantly lower in the coiling group [RR=0.52, CI:0.37-0.74].
    • Risk of late rebleeding is low, but was found to be more common after coiling than after clipping.



    Reference:

    Lancet

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67214-5/fulltext

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