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The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms : 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial ( ISAT ) . BACKGROUND Previous analyses of the International Subarachnoid Aneurysm Trial ( ISAT ) cohort have reported on the risks of recurrent subarachnoid haemorrhage and death or dependency for a minimum of 5 years and up to a maximum of 14 years after treatment of a ruptured intracranial aneurysm with either neurosurgical clipping or endovascular coiling . At 1 year there was a 7 % absolute and a 24 % relative risk reduction of death and dependency in the coiling group compared with the clipping group , but the medium-term results showed the increased need for re-treatment of the target aneurysm in the patients given coiling . We report the long-term follow-up of patients in this UK cohort . METHODS In ISAT , patients were randomly allocated to either neurosurgical clipping or endovascular coiling after a subarachnoid haemorrhage , assuming treatment equipoise , between Sept 12 , 1994 , and May 1 , 2002 . We followed up 1644 patients in 22 UK neurosurgical centres for death and clinical outcomes for 10·0-18·5 years . We assessed dependency as self-reported modified Rankin scale score obtained through yearly questionnaires . Data for recurrent aneurysms and rebleeding events were collected from questionnaires and from hospital and general practitioner records . The Office for National Statistics supplied data on deaths . This study is registered , number ISRCTN49866681 . FINDINGS At 10 years , 674 ( 83 % ) of 809 patients allocated endovascular coiling and 657 ( 79 % ) of 835 patients allocated neurosurgical clipping were alive ( odds ratio [ OR ] 1·35 , 95 % CI 1·06-1·73 ) . Of 1003 individuals who returned a questionnaire at 10 years , 435 ( 82 % ) patients treated with endovascular coiling and 370 ( 78 % ) patients treated with neurosurgical clipping were independent ( modified Rankin scale score 0-2 ; OR 1·25 ; 95 % CI 0·92-1·71 ) . Patients in the endovascular treatment group were more likely to be alive and independent at 10 years than were patients in the neurosurgery group ( OR 1·34 , 95 % CI 1·07-1·67 ) . 33 patients had a recurrent subarachnoid haemorrhage more than 1 year after their initial haemorrhage ( 17 from the target aneurysm ) . INTERPRETATION Although rates of increased dependency alone did not differ between groups , the probability of death or dependency was significantly greater in the neurosurgical group than in the endovascular group . Rebleeding was more likely after endovascular coiling than after neurosurgical clipping , but the risk was small and the probability of disability-free survival was significantly greater in the endovascular group than in the neurosurgical group at 10 years . FUNDING UK Medical Research Council .
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Intervention_Physical
endovascular coiling
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Intervention_Surgical
neurosurgical clipping
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Intervention_Surgical
neurosurgical clipping
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Intervention_Physical
endovascular coiling
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Participant_Condition
ruptured cerebral aneurysms :
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Participant_Condition
UK cohort of the International Subarachnoid Aneurysm Trial ( ISAT )
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Participant_Condition
International Subarachnoid Aneurysm Trial ( ISAT ) cohort
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Participant_Sample-size
1644