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