Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT)

Adriana Campi, Najib Ramzi, Andrew J. Molyneux, Paul E. Summers, Richard S C Kerr, Mary Sneade, Julia A. Yarnold, Joan Rischmiller, James V. Byrne

Research output: Contribution to journalArticle

320 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - Because the long-term security of endovascular treatments remains uncertain, a follow-up study of the patients treated in the International Subarachnoid Aneurysm Trial was performed to compare the frequency, timing, and consequences of aneurysm recurrence. METHODS - Patient data were reclassified by actual treatment performed. Aneurysm and patient characteristics, including occlusion grades, time and type of retreatment, and clinical outcomes, were compared. The relationship between these variables and late retreatment as a surrogate for recurrence was analyzed by means of the Cox proportional hazards model. RESULTS - Retreatment was performed in 191 of 1096 (17.4%) patients after primary endovascular coiling (EVT) and in 39 of 1012 patients (3.8%) after neurosurgical clipping. After EVT, 97 (8.8%) patients were retreated early and 94 (9.0%) late, 7 (0.6%) after rebleeding and 87 (8.3%) without. The mean time to late retreatment was 20.7 months. After neurosurgical clipping, 30 (2.9%) patients were retreated early and 9 (0.85%) late, 3 (0.3%) after rebleeding and 6 (0.6%) without. The mean time to late retreatment was 5.7 months. The hazard ratio (HR) for retreatment after EVT was 6.9 (95% CI=3.4 to 14.1) after adjustment for age (P=0.001, HR=0.97, 95% CI=0.95 to 0.98), lumen size (P=0.006, HR=1.1, 95% CI=1.03 to 1.18), and incomplete occlusion (P

Original languageEnglish
Pages (from-to)1538-1544
Number of pages7
JournalStroke
Volume38
Issue number5
DOIs
Publication statusPublished - May 2007

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Ruptured Aneurysm
Retreatment
Intracranial Aneurysm
Aneurysm
Recurrence
Proportional Hazards Models
Therapeutics

Keywords

  • Aneurysm
  • Rebleeding
  • Recurrence
  • Retreatments
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). / Campi, Adriana; Ramzi, Najib; Molyneux, Andrew J.; Summers, Paul E.; Kerr, Richard S C; Sneade, Mary; Yarnold, Julia A.; Rischmiller, Joan; Byrne, James V.

In: Stroke, Vol. 38, No. 5, 05.2007, p. 1538-1544.

Research output: Contribution to journalArticle

Campi, A, Ramzi, N, Molyneux, AJ, Summers, PE, Kerr, RSC, Sneade, M, Yarnold, JA, Rischmiller, J & Byrne, JV 2007, 'Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT)', Stroke, vol. 38, no. 5, pp. 1538-1544. https://doi.org/10.1161/STROKEAHA.106.466987
Campi, Adriana ; Ramzi, Najib ; Molyneux, Andrew J. ; Summers, Paul E. ; Kerr, Richard S C ; Sneade, Mary ; Yarnold, Julia A. ; Rischmiller, Joan ; Byrne, James V. / Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). In: Stroke. 2007 ; Vol. 38, No. 5. pp. 1538-1544.
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AU - Campi, Adriana

AU - Ramzi, Najib

AU - Molyneux, Andrew J.

AU - Summers, Paul E.

AU - Kerr, Richard S C

AU - Sneade, Mary

AU - Yarnold, Julia A.

AU - Rischmiller, Joan

AU - Byrne, James V.

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N2 - BACKGROUND AND PURPOSE - Because the long-term security of endovascular treatments remains uncertain, a follow-up study of the patients treated in the International Subarachnoid Aneurysm Trial was performed to compare the frequency, timing, and consequences of aneurysm recurrence. METHODS - Patient data were reclassified by actual treatment performed. Aneurysm and patient characteristics, including occlusion grades, time and type of retreatment, and clinical outcomes, were compared. The relationship between these variables and late retreatment as a surrogate for recurrence was analyzed by means of the Cox proportional hazards model. RESULTS - Retreatment was performed in 191 of 1096 (17.4%) patients after primary endovascular coiling (EVT) and in 39 of 1012 patients (3.8%) after neurosurgical clipping. After EVT, 97 (8.8%) patients were retreated early and 94 (9.0%) late, 7 (0.6%) after rebleeding and 87 (8.3%) without. The mean time to late retreatment was 20.7 months. After neurosurgical clipping, 30 (2.9%) patients were retreated early and 9 (0.85%) late, 3 (0.3%) after rebleeding and 6 (0.6%) without. The mean time to late retreatment was 5.7 months. The hazard ratio (HR) for retreatment after EVT was 6.9 (95% CI=3.4 to 14.1) after adjustment for age (P=0.001, HR=0.97, 95% CI=0.95 to 0.98), lumen size (P=0.006, HR=1.1, 95% CI=1.03 to 1.18), and incomplete occlusion (P

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KW - Aneurysm

KW - Rebleeding

KW - Recurrence

KW - Retreatments

KW - Subarachnoid hemorrhage

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