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Arterial Pouch Microsurgical Bifurcation Aneurysm Model in the Rabbit

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The Barrow Ruptured Aneurysm Trial.

Cameron G McDougall¹, Robert F Spetzler, Joseph M Zabramski

¹Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. neuropub@chw.edu

Journal of Neurosurgery

|November 8, 2011

Summary

This summary is machine-generated.

Endovascular coil embolization for ruptured cerebral aneurysms led to better outcomes than surgical clipping at one year. This study compared safety and efficacy, finding coil embolization superior for patients with subarachnoid hemorrhage.

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Area of Science:

Neurosurgery
Interventional Neuroradiology
Vascular Neurology

Background:

Aneurysmal subarachnoid hemorrhage (SAH) is a critical condition requiring prompt treatment.
Microsurgical clipping and endovascular coil embolization are primary treatment modalities for ruptured cerebral aneurysms.
Comparative data on long-term outcomes between these treatments are essential for clinical decision-making.

Purpose of the Study:

To compare the safety and efficacy of microsurgical clipping versus endovascular coil embolization for acutely ruptured cerebral aneurysms.
To determine if one treatment modality is superior by examining clinical and angiographic outcomes at one year.
To test the null hypothesis of no difference in outcomes between the two treatments.

Main Methods:

Prospective enrollment of 500 eligible patients with SAH, randomly assigned to either clipping or coil embolization.
Independent assessment of outcomes using the modified Rankin Scale (mRS) at one year.
Intent-to-treat analysis based on initial treatment assignment, with standardized post-treatment care.

Main Results:

At one year, 403 patients were evaluated; 33.7% of clipping patients had poor outcomes (mRS > 2) versus 23.2% of coil embolization patients (p=0.02).
Patients initially assigned to coil embolization experienced fewer poor outcomes, irrespective of crossover to clipping.
No recurrent hemorrhage occurred in patients treated with coil embolization.

Conclusions:

An intent-to-treat strategy favoring coil embolization resulted in significantly better clinical outcomes at one year post-treatment for ruptured cerebral aneurysms.
Despite a substantial crossover rate from coil to clip, the coil-first policy demonstrated superiority.
High-quality surgical clipping remains a crucial alternative treatment option.