Interventional technique tops surgery for ruptured brain aneurysms
Endovascular coil embolization provides a clear advantage over surgical repair for patients suffering from ruptured brain aneurysms, according to initial results from the International Subarachnoid Aneurysm Trial (ISAT).
In fact, the interim results from the multicenter trial were so conclusive, further recruitment for the trial was halted.
"I don't think a further randomized trial regarding ruptured aneurysms is now possible, though our colleagues in the U.S. want to do one. Obtaining the consent of patients in light of ISAT data would be difficult," said Dr. Andrew J. Molyneux, coprincipal investigator of the study and president of the British Society of Neuroradiologists.
Molyneux and colleagues studied the interventional technique in 2143 patients with ruptured intracranial aneurysms. The technique, first used in the U.S. in 1990 and in Europe in 1992, received FDA approval in 1995. Endovascular embolization was initially used only for surgically difficult or impossible aneurysms.
The researchers randomly assigned 1070 patients to receive the neurosurgical clipping treatment and 1073 patients to receive the endovascular treatment using detachable platinum coils. After following up clinical outcomes at two months and at one year, the research team found that the endovascular technique reduced the relative risk of severe and permanent disability or death by 22.6%. The absolute risk reduction of the interventional technique compared with traditional surgery was 6.9%.
Results of the randomized multicenter trial were published in the Oct. 26 issue of The Lancet.
The endovascular technique is not only less invasive than surgery, it would most likely result in shorter hospital stays, according to Molyneux.
"The main contraindication is the anatomical unsuitability of the aneurysm, although with new coils and techniques, this represents a small proportion of the patients," he said.
While Molyneux and colleagues found the interventional treatment trumped neurosurgical clipping in the short term, the researchers will continue to follow up patient outcomes for an additional five years to see if the immediate benefits have any long-term significance.
"There is still a question if a randomized trial of unruptured aneurysms would be possible. But consent issues would be difficult, and the study would take a long time," Molyneux said.
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