Less-Invasive Surgery Found Best for Brain Aneurysm

Results from the International Subarachnoid Aneurysm Trial (ISAT) demonstrate that less-invasive endovascular treatment with detachable platinum coils produces better outcomes for patients with ruptured brain aneurysms than neurosurgical clipping. Published in the October 25, 2002, issue of The Lancet, the study showed that the risk of death or significant disability at one year for patients treated endovascularly with coils was 22.6% lower than for patients treated with clipping.

Results from an interim analysis of the data were so compelling that the trial was halted early after enrolling 2,143 of the planned 2,500 patients, because the Trial Steering Committee determined it was no longer ethical to randomize patients to neurosurgical clipping. Centers in Australia, Europe, and Australia participated.

As the only multicenter, prospective, randomized trial comparing endovascular coiling of ruptured brain aneurysms to neurosurgical clipping, ISAT demonstrated that in patients equally suited for either treatment, coiling provides better outcomes in terms of survival free of disability at one year.

Neurosurgical clipping involves performing a craniotomy and placing a surgical clip at the neck of the aneurysm. Endovascular treatment, introduced in the early 1990s, involves insertion of a catheter into the femoral artery in the patient's leg and navigating it through the vascular system under x-ray guidance into the head and into the aneurysm. Tiny platinum coils are then threaded through the catheter and deployed into the aneurysm, obstructing blood flow into the aneurysm and preventing further damage.

"This study was designed to provide results that will help guide physician practice,” said Richard Kerr, M.D., neurosurgical principal investigator of ISAT and a consultant neurosurgeon with the department of neurosurgery at the Radcliffe Infirmary in Oxford (UK). "For patients with ruptured brain aneurysms suitable for both treatments, endovascular coiling is significantly more likely to leave patients alive and free of disability. However, as in any study, long-term follow-up will be essential to evaluate the substantial early advantage of endovascular coil treatment.”

All of the endovascular patients in the study with one-year follow-up were treated using the GDCTM coil of Target Therapeutics, part of Boston Scientific (MA, USA).




Related Links:
Radcliffe Infirmary
Boston Scientific