[en] BACKGROUND: Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed and are commonly treated using endovascular treatment or microsurgical clipping. The safety and efficacy of treatments have not been compared in a randomised trial. How to treat patients with UIAs suitable for both options remains unknown. METHODS: We randomly allocated clipping or coiling to patients with one or more 3-25 mm UIAs judged treatable both ways. The primary outcome was treatment failure, defined as: initial failure of aneurysm treatment, intracranial haemorrhage or residual aneurysm on 1-year imaging. Secondary outcomes included neurological deficits following treatment, hospitalisation >5 days, overall morbidity and mortality and angiographic results at 1 year. RESULTS: The trial was designed to include 260 patients. An analysis was performed for slow accrual: 136 patients were enrolled from 2010 through 2016 and 134 patients were treated. The 1-year primary outcome, available for 104 patients, was reached in 5/48 (10.4% (4.5%-22.2%)) patients allocated surgical clipping, and 10/56 (17.9% (10.0%-29.8%)) patients allocated endovascular coiling (OR: 0.54 (0.13-1.90), p=0.40). Morbidity and mortality (modified Rankin Scale>2) at 1 year occurred in 2/48 (4.2% (1.2%-14.0%)) and 2/56 (3.6% (1.0%-12.1%)) patients allocated clipping and coiling, respectively. New neurological deficits (15/65 vs 6/69; OR: 3.12 (1.05-10.57), p=0.031), and hospitalisations beyond 5 days (30/65 vs 6/69; OR: 8.85 (3.22-28.59), p=0.0001) were more frequent after clipping. CONCLUSION: Surgical clipping or endovascular coiling of UIAs did not show differences in morbidity at 1 year. Trial continuation and additional randomised evidence will be necessary to establish the supposed superior efficacy of clipping.
Disciplines :
Neurology Surgery
Author, co-author :
Darsaut, Tim E.
Findlay, J. Max
Magro, Elsa
Kotowski, Marc
Roy, Daniel
Weill, Alain
Bojanowski, Michel W.
Chaalala, Chiraz
Iancu, Daniela
Lesiuk, Howard
Sinclair, John
Scholtes, Félix ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Neuro-anatomie
Martin, Didier ; Université de Liège - ULiège > Département des sciences cliniques > Neurochirurgie
Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomised trial.
Publication date :
2017
Journal title :
Journal of Neurology, Neurosurgery and Psychiatry
ISSN :
0022-3050
eISSN :
1468-330X
Publisher :
BMJ Publishing Group, United Kingdom
Volume :
88
Issue :
8
Pages :
663-668
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
(c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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