International Subarachnoid Aneurysm Trial (ISAT) of Neurosurgical Clipping Versus Endovascular Coiling in 2143 Patients With Ruptured Intracranial Aneurysms: A Randomised Comparison of Effects on Survival, Dependency, Seizures, Rebleeding, Subgroups, and Aneurysm Occlusion

Uneventful delivery with caesarean section in a woman with a history of endovascular management of an intracranial aneurysm

“…In some of these cases, vaginal delivery was elected and was uneventful (Kizilkilic et al 2003;Meyers et al 2000;Piotin et al 2001). However, a large randomised study in non-pregnant women showed that endovascular management of ruptured intracranial aneurysms is associated with a greater risk for late re-bleeding than surgical management (Molyneux et al 2005). Th erefore, it was suggested that a scheduled caesarean section is preferred in women who have undergone endovascular management because there is a risk of rupture due to incomplete occlusion (Nelson 2005;Selo-Ojeme et al 2004).…”

“…Given the greater risk of late bleeding of intracranial aneurysms aft er endovascular management (Molyneux et al 2005), surgery might represent a more appropriate treatment of intracranial aneurysms than endovascular management in women of reproductive age or in pregnant women.…”

“…Endovascular management is the treatment of choice of ruptured intracranial aneurysms, as it is associated with a lower risk of dependency or death than surgical management (Molyneux et al 2005). However, the management of women who have undergone endovascular management of intracranial aneurysms and become pregnant is unclear.…”

“…Pregnancy increases the risk for aneurysm rupture (Nelson 2005;Selo-Ojeme et al 2004;Stoodley et al 1998). In addition, there appears to be a greater risk of late bleeding of intracranial aneurysms aft er endovascular management (Molyneux et al 2005). Arteriovenous malformations, which are the cause of one-quarter of cases of intracranial haemorrhage during pregnancy, might diff er from intracranial aneurysms in the risk of rupture and in their management during pregnancy (Dias and Sekhar 1990).…”

Unruptured intracranial aneurysms: Comparison of perioperative complications, discharge disposition, outcome, and effect of calcification, between clipping and coiling: A single institution experience

“…[3] The International Subarachnoid Hemorrhage Treatment Trial (ISAT) trial for ruptured aneurysms demonstrated that, endovascular coiling is superior to clipping in terms of functional outcome, mortality, and epilepsy rates at 1 year. [5] However, similar randomized controlled trials for UIAs to compare treatment options are not available. Numerous studies have demonstrated the efficacy of clipping over coiling and otherwise, however, they are biased by physician preference and selection of a nonrepresentative subgroup of patients.…”