Mid-Term Anatomic Results after Endovascular Treatment of Ruptured Intracranial Aneurysms with Guglielmi Detachable Coils and Matrix Coils: Analysis of the CLARITY Series

Piérot, Laurent; Cognard, Christophe; Ricolfi, F.; Anxionnat, René

doi:10.3174/ajnr.a2771

Cited by 50 publications

(40 citation statements)

References 14 publications

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“…Unfortunately, such statements are common: for example, "After the international subarachnoid aneurysm trial (ISAT), which showed better outcomes with endovascular coiling than with neurosurgical clipping for the treatment of intracranial aneurysms, endovascular coiling is the preferred treatment for many patients" 31 or "In the European practice, endovascular treatment with coils is now the first treatment technique of choice for both unruptured and ruptured aneurysms." 22 However, the 3-year follow-up data from BRAT and the 5-year follow-up data from ISAT now show that the benefit of coiling is less clear-cut. Even more critical is that when anterior circulation aneurysms are considered alone in BRAT, there was no benefit to coiling at any time point despite a crossover rate of 42%.…”

Section: Evolution Of Treatmentmentioning

confidence: 99%

The Barrow Ruptured Aneurysm Trial: 3-year results

Spetzler

McDougall

Albuquerque

et al. 2013

JNS

269

171

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Object The authors report the 3-year results of the Barrow Ruptured Aneurysm Trial (BRAT). The objective of this ongoing randomized trial is to compare the safety and efficacy of microsurgical clip occlusion and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to compare functional outcomes based on clinical and angiographic data. The 1-year results have been previously reported. Methods Two-hundred thirty-eight patients were assigned to clip occlusion and 233 to coil embolization. There were no anatomical exclusions. Crossovers were allowed based on the treating physician's determination, but primary outcome analysis was based on the initial assignment to treatment modality. Patient outcomes were assessed independently using the modified Rankin Scale (mRS). A poor outcome was defined as an mRS score > 2. At 3 years' follow-up 349 patients who had actually undergone treatment were available for evaluation. Of the 170 patients who had been originally assigned to coiling, 64 (38%) crossed over to clipping, whereas 4 (2%) of 179 patients assigned to surgery crossed over to coiling. Results The risk of a poor outcome in patients assigned to clipping compared with those assigned to coiling (35.8% vs 30%) had decreased from that observed at 1 year and was no longer significant (OR 1.30, 95% CI 0.83–2.04, p = 0.25). In addition, the degree of aneurysm obliteration (p = 0.0001), rate of aneurysm recurrence (p = 0.01), and rate of retreatment (p = 0.01) were significantly better in the group treated with clipping compared with the group treated with coiling. When outcomes were analyzed based on aneurysm location (anterior circulation, n = 339; posterior circulation, n = 69), there was no significant difference in the outcomes of anterior circulation aneurysms between the 2 assigned groups across time points (at discharge, 6 months, 1 year, or 3 years after treatment). The outcomes of posterior circulation aneurysms were significantly better in the coil group than in the clip group after the 1st year of follow-up, and this difference persisted after 3 years of follow-up. However, while aneurysms in the anterior circulation were well matched in their anatomical location between the 2 treatment arms, this was not the case in the posterior circulation where, for example, 18 of 21 posterior inferior cerebellar artery aneurysms were in the clip group. Conclusions Based on mRS scores at 3 years, the outcomes of all patients assigned to coil embolization showed a favorable 5.8% absolute difference compared with outcomes of those assigned to clip occlusion, although this difference did not reach statistical significance (p = 0.25). Patients in the clip group had a significantly higher degree of aneurysm obliteration and a significantly lower rate of recurrence and retreatment. In post hoc analysis examining only anterior circulation aneurysms, no outcome difference between the 2 treatment cohorts was observed at any recorded time point. Clinical trial registration no.: NCT01593267 (ClinicalTrials.gov).

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Section: Evolution Of Treatmentmentioning

confidence: 99%

The Barrow Ruptured Aneurysm Trial: 3-year results

Spetzler

McDougall

Albuquerque

et al. 2013

JNS

269

171

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“…Thirty-one of the 104 studies (29.8%) used multiple readers. Two of these studies, CLARITY 24 and French Matrix Registry, 25 were core laboratory studies. Table 1 presents baseline factors that have previously been associated with unfavorable outcomes, including aneurysm size, follow-up duration, and initial rupture status.…”

Section: Resultsmentioning

confidence: 99%

“…The literature review encompassed 4019 articles published between January 1999 and December 2011, as well as 3 core laboratory studies identified from 2011-2012 annual meetings [22][23][24] The total number of treated aneurysms among these 104 included studies was 22,134, of which 15,969 (72.1%) had available angiographic follow-up outcomes. The mean aneurysm size was reported in 72 (69.2%) of 104 studies.…”

Section: Resultsmentioning

confidence: 99%

Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis

Rezek¹,

Mousan

Wang

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Reported rates of recanalization following coil embolization vary widely across studies. Some confounders are known to affect outcomes but others remain questionable. In the current study, we assess differences in reported angiographic outcomes for cerebral aneurysms treated with coil embolization as a function of single vs multiple readers and site investigator vs core laboratory settings.

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“…1,4,7 Similarly, deterioration in angiographic occlusion between treatment and early angiographic follow-up is in the range of 35%-50%. 5,10 Are these patients shouldering the bulk of rehemorrhages while we reassure them by quoting low rehemorrhage rates that use the entire population ("adequate" and "inadequately" occluded) as the denominator? We do not and cannot know until we track, measure, and correlate TAR with angiographic end points.…”

Section: Why "Adequate Occlusion" Is Inadequatementioning

confidence: 99%