[Clipping comparable to coiling in intracranial aneurysm].

Area of Science:

• Neurosurgery
• Interventional Neurology
• Vascular Neurology

Background:

• Subarachnoid hemorrhage (SAH) is a critical neurovascular condition often caused by ruptured intracranial aneurysms.
• Treatment decisions involve balancing risks and benefits between endovascular coiling and neurosurgical clipping.
• Long-term outcome data are crucial for guiding clinical practice.

Purpose of the Study:

• To present the 10-year follow-up results of the International Subarachnoid Aneurysm Trial (ISAT).
• To compare the long-term functional outcomes and survival rates between endovascular coiling and neurosurgical clipping for ruptured intracranial aneurysms.

Main Methods:

• The study is a 10-year follow-up of the ISAT, a randomized controlled trial.
• Participants were patients with ruptured intracranial aneurysms randomized to either endovascular coiling or neurosurgical clipping.
• Functional outcome (primary endpoint) and cumulative mortality were analyzed using modified intention-to-treat principles.

Main Results:

• No significant differences in functional outcome were observed between endovascular coiling and neurosurgical clipping at 10-year follow-up.
• Initial claims of mortality benefit for coiling were not sustained upon modified intention-to-treat analysis.
• Survival rates between the two treatment groups were not significantly different in the long term.

Conclusions:

• Both endovascular coiling and neurosurgical clipping are considered viable treatment options for ruptured intracranial aneurysms.
• The 10-year data reinforce the equipoise between these two major treatment modalities.
• Long-term functional outcomes and survival do not significantly differ between coiling and clipping.