International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomized trial

Molyneux, Andrew; Kerr, Richard; Stratton, Irene; Sandercock, Peter; Clarke, Mike; Shrimpton, Julia A; Holman, Rury R.

doi:10.1053/jscd.2002.130390

Cited by 424 publications

(299 citation statements)

References 23 publications

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“…3,15,45,47,48) Since the overall surgical outcome for ruptured aneurysms remains unsatisfactory, preventive radical clipping and endovascular surgery are considered alternative strategies. 16,26,48) The endovascular approach using Guglielmi detachable coils (GDCs) has improved the overall treatment of patients with incidental aneurysms. 29,36) Recanalization or progressive thrombosis may occur in the short or medium term after the endovascular treatment of ruptured aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

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Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…Despite the proven efficacy of endovascular coil embolization for the treatment of ruptured intracranial aneurysm reported in International Subarachnoid Aneurysm Trial [12], long-term durability still remains a major handicap of this treatment technique. Among the many factors leading to recurrence, initial low packing density and subtotal obliteration are regarded as prominent impacting factors.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular embolization has become an effective modality for the treatment of intracranial aneurysms; however, relatively greater recurrence rate remains one of the major handicaps of this technique [1]. Low packing density is among the various factors potentially affecting aneurysm recurrence [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Che

Hong

et al. 2013

Cardiovasc Intervent Radiol

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Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coils in treating ruptured aneurysms at the anterior circulation compared with bare platinum coils. Materials and Methods Patients with aneurysmal subarachnoid hemorrhages admitted to our hospital between January 2009 and March 2012 were retrospectively analyzed. According to strict inclusion and exclusion criteria, cases were selected and classified into two groups: In group A, HydroSoft coils were used as the primary filling coils (C40 % of total coil length); in group B, only bare platinum coils were used. Cases in both groups were all treated with stent-assistance. A comparison between the two groups was performed for periprocedural complications as well as immediate and mid-term outcomes. The stents used included Enterprise, Neuroform, and Solitaire.Results Fifty-six aneurysms were in group A patients, and 68 aneurysms were in group B patients. Compared with group B, group A did not have increased incidence of complications but had greater packing attenuation (44.5 ± 8.8-29.8 ± 9.1 %, t = 2.577, P = 0.014) and increased initial complete occlusion rates (63-44 %, v 2 = 4.161, P = 0.041). Radiologic follow-up were performed in 46 patients from group A and 51 patients from group B. Complete occlusion rates at follow-up were significantly greater in group A than in group B (89.1-70.6 %, v 2 = 5.08, P = 0.043); the difference in recanalization rates were statistically insignificant between the groups (6.5-5.9 %, P = 1.000). Conclusion HydroSoft coils proved safe during the periprocedural period and provided greater initial complete occlusion rates, greater packing density, and better followup results compared with bare platinum coils.

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“…In a selected group of patients, endovascular and neurosurgical clip application are judged to be equivalent therapeutic options 1,2 . However, growth of the aneurysm after coiling and subsequent rebleeding have been reported 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular treatment with detachable coils has become an established technique for patients with intracranial aneurysm and has been associated with a better outcome than surgery at 1-year after treatment 1,2 . However, aneurysm may partially recur due to coil compaction or enlargement of a remnant.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of endovascular coil embolization for cerebral aneurysms using three-dimensional time-of-flight magnetic resonance angiography

Hayashi

Kitagawa

Morikawa

et al. 2009

Neurological Research

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Objectives: As endovascular treatment becomes more prevalent, aneurysm recurrence from neck remnants, recanalization, incomplete obliteration and bleeding remain major concerns. In the current analysis, we attempted to identify factors related to disease progression and clinical outcome in patients treated with coil embolization. Methods: This study included 58 patients who underwent endovascular coil embolization for treatment of intracranial aneurysm. The result of embolization was evaluated with threedimensional time-of-flight magnetic resonance angiography (TOF MRA) and classified as a complete occlusion, a residual neck (minor, central and marginal types), a residual dome (central and marginal types). Patients were followed up clinically and radiologically. Statistical analyses were performed to establish factors that influenced the occurrence of adverse events such as recurrence of aneurysm. Results: Overall, the complete occlusion rate was 18.8%, the occurrence of a residual neck was 67.2%, and the residual dome rate was 14.1%. The mean clinical follow-up was 31.2 months. Recurrences were found in 18 aneurysms, and major recurrences were retreated with coiling or surgery. The post-treatment study revealed that the marginal-type aneurysm filling has a significant impact on outcome. Thus, perianeurysmal edema was correlated with recurrence of the aneurysm. Conclusions: Three-dimensional TOF MRA was a sensitive tool for visualizing residual filling of embolized aneurysm and is useful for long-term follow-up of patients. [Neurol Res 2008; 000: 000-000]

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International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomized trial

Cited by 424 publications

References 23 publications

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Long-term follow-up of endovascular coil embolization for cerebral aneurysms using three-dimensional time-of-flight magnetic resonance angiography

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