Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to ...Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.展开更多
文摘Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.
