What is the evidence to support the use of clipping or coiling in the management of a ruptured aneurysm following subarachnoid haemorrhage (SAH)?

  • The largest trial comparing surgical and endovascular management of ruptured aneurysms is the ISAT trial:
Intervention
Population
Conclusion

RCT: ISAT

Molyneux et al
Lancet (2002)

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  • Endovascular coiling vs. surgical clipping for acute ruptured intracranial aneurysm
  • 2143 with ruptured intracranial aneurysms
  • Risk of death or dependence at 1 year (primary outcome) was significantly less common in those that received endovascular coiling (23.5% vs 30.9%, ARR 6-9%, 95%CI 3.6 - 11.2%)
  • Longer term follow-up from this trial has raised concerns about delayed re-bleeding and higher need for retreatment