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Subarachnoid Hemorrhage
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Dominic A. Harris, Ajith J. Thomas
Currently, endovascular coiling is preferred compared to neurosurgical clipping in aneurysmal subarachnoid hemorrhage patients who are considered equally suitable for both treatment options. This shift has been largely influenced by the findings from the International Subarachnoid Aneurysm Trial (ISAT) [4] which is one of the landmark papers that has dramatically changed the field of vascular neurosurgery.
Central nervous system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
The initial findings of the International Subarachnoid Aneurysm Trial (ISAT) favoured endovascular coiling as the treatment for ruptured intracranial aneurysm, giving an absolute risk reduction of 6%–9%. Clipping is still used when coiling is unsuitable such as in middle cerebral artery aneurysms and aneurysms with a wide neck.
Landmark publications
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Molyneux A, Kerr R, Stratton I, et al. (International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group). International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360(9342): 1267–1274.
Management of aneurysmal subarachnoid haemorrhage 17 years after the ISAT trial: a survey of current practice in the UK and Ireland
Published in British Journal of Neurosurgery, 2020
Mark Jernej Zorman, Robert Iorga, Ruichong Ma, Umang Jash Patel
In 1994, Richard Kerr and Andrew Molyneux from Oxford, UK, commenced a prospective randomised trial, the International Subarachnoid Aneurysm Trial (ISAT), comparing safety and efficacy of endovascular coiling versus surgical clipping in patients with recently ruptured cerebral aneurysms. A total of 2143 patients from 43 centres were randomly assigned to clipping (n = 1070) or coiling (n = 1073). At one year the outcome was assessed with a modified Rankin score dichotomised at 36; that is good recovery versus dependent or dead. A significant difference was found between the groups and the trial was terminated early by the monitoring committee. 22.7% of coiled patients were dependent or dead compared with 30.6% of those subjected to surgery.1 The annual risk of rebleeding after coiling was 0.16% (2 cases per 1276 patient years) versus zero for clipping.1
Microsurgical treatment for unruptured intracranial aneurysms: a modern single surgeon series
Published in British Journal of Neurosurgery, 2019
J. A. Kosty, N. O. Andaluz, Y. M. Gozal, B. M. Krueger, J. Scoville, M. Zuccarello
The management of unruptured intracranial aneurysms (UIAs) is controversial, with options including observation, endovascular treatment, and microsurgery. In 2003, the prospective arm of the largest UIA study to date, the International Study of Unruptured Intracranial Aneurysms (ISUIA), reported higher rates of morbidity and mortality for microsurgery compared to both endovascular treatment and the risk of rupture for anterior circulation aneurysms measuring less than 12 mm in diameter.1 Similarly, the International Subarachnoid Aneurysm Trial (ISAT) reported a lower rate of death and dependency in patients treated with endovascular interventions compared to surgical intervention.2
Comparison between outcomes of endovascular and surgical treatments of ruptured anterior communicating artery aneurysms
Published in British Journal of Neurosurgery, 2021
Lauren Harris, Ciaran Scott Hill, Matthew Elliot, Teresa Fitzpatrick, Anthony Ghosh, Raghu Vindlacheruvu
The International Subarachnoid Aneurysm Trial (ISAT) and other studies have shown patients with ruptured aneurysms may have significant advantages in disability independent survival and functional outcomes when treated endovascularly versus surgically.1,6–10 Reported disadvantages of endovascular treatment include rebleeding and recurrence, and questions remain about the durability of coils over time.1,2,5,9–13