A Long-Term View at Clipping Versus Coiling for Ruptured Aneurysm

Excerpt

The results of the long-term follow-up of the ISAT patients are mostly confirmatory [1]. ISAT remains the most influential trial comparing clipping versus coiling of ruptured aneurysms. Only cases that fulfilled the condition of clinical equipoise were enrolled. In other words, only patients who were considered adequate candidates for clipping and for coiling were randomized. The initial report of the results of the study indicated that coiling was associated with a relative reduction in the risk of death and dependency at 1 year of 23.9% compared with clipping (absolute risk reduction 7.4%) [2]. During the first year after treatment, coiled patients had a slightly higher incidence of rebleeding from the treated aneurysm and required re-treatment (typically additional coiling) 6.9 times more often than clipped patients [2, 3]. However, there were concerns about the durability of coiling in patients who are often quite young at the time of their subarachnoid hemorrhage. …