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International subarachnoid Aneurysm Trial (ISAT)

2143 patients. Endovascular coiling with detachable platinum coil device vs surgical clipping of ruptured intracranial aneurysm. At 1 year: - 24% of coiled patients dead or dependent - 31% of clipped patients dead or dependent At 7 years mortality was higher in the clipping group. [2] - rebleeding from the target aneurysm was similar in both groups during the 1st year, but the coiling group had more later rebleeds (7 vs 2) [2] Fewer seizures occurred in the coiling group. At 10 years, outcomes better in the coiling group (mortality 17% vs 21%) [3] - more rebleeding in the coiling group, 13 vs 6 of 1644 patients, but only 6 of 13 vs 4 of 6 rebleeds resulted in death or dependency [3]

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clinical trial

References

  1. Journal Watch 23(1):2, 2003 International subarachnoid Aneurysm Trial (ISAT) Collaborative Group, Lancet 360:1267, 2002 Nichols DA et al, Lancet 360:1262, 2002
  2. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; 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 comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005 Sep 3-9;366(9488):809-17. PMID: 16139655 - Britz GW. ISAT trial: coiling or clipping for intracranial aneurysms? Lancet. 2005 Sep 3-9;366(9488):783-5. No abstract available. PMID: 16139637
  3. Molyneux AJ et al. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 2014 Oct 28 PMID: 25465111 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960975-2/fulltext