Survival, Dependency, and Health-Related Quality of Life in Patients With Ruptured Intracranial Aneurysm: 10-Year Follow-up of the United Kingdom Cohort of the International Subarachnoid Aneurysm Trial

Abstract

BACKGROUND Previous analyses of the International Subarachnoid Aneurysm Trial (ISAT) cohort have reported on clinical outcomes after treatment of a ruptured intracranial aneurysm with either neurosurgical clipping or endovascular coiling. OBJECTIVE To evaluate the long-term quality-adjusted life years (QALYs) gained of endovascular coiling compare to neurosurgical clipping in the UK cohort of ISAT. METHODS Between September 12, 1994 and May 1, 2002, patients with ruptured intracranial aneurysms who were assumed treatment equipoise were randomly allocated to either neurosurgical clipping or endovascular coiling. We followed-up 1644 patients in 22 UK neurosurgical centers for a minimum of 10 yr. Health-related quality of life (HRQoL) was collected through yearly questionnaires, measured by utilities calculated from the EQ-5D-3L. We compared HRQoL between the 2 treatment groups over a period of 10 yr. In all, 1-yr, 5-yr, and 10-yr QALYs were estimated by combining utility and survival information. RESULTS Higher average utility values were found in the endovascular group throughout the follow-up period, with mean differences between groups statistically significant in most years. The 10-yr QALYs were estimated to be 6.68 (95% CI: 6.45-6.90) in the coiling group and 6.32 (95% CI: 6.10-6.55) in the clipping group, respectively, a significant mean difference of 0.36 (95% CI: 0.04-0.66). A third of this mean QALYs gain was estimated to derive solely from HRQoL differences. CONCLUSION HRQoL after treatment of a ruptured intracranial aneurysm was better after endovascular coiling compared to neurosurgical clipping, which contributed significantly to the QALYs gained over a 10-yr period.

DCI after Aneurysmal Subarachnoid Hemorrhage Is Related to the Expression of MFG-E8

“…Aneurysmal subarachnoid hemorrhage (aSAH) is an acute and critical disease with high morbidity and mortality [1][2][3][4]. Some surviving patients show clear cognitive impairment or even lifelong disability [5].…”

Quality of Life After Poor-Grade Aneurysmal Subarachnoid Hemorrhage

“…Most studies reporting on QoL after aSAH share the limitation of mixing good-grade and poor-grade patients or analyzing cohorts in which poor-grade patients are underrepresented. [3][4][5][6][7][8] Others are limited by relatively small cohort sizes [18][19][20][21][22] or are subject to missing data issues. 9 In our study, survivors reported mainly impairment during usual activities, whereas anxiety and depression, as well as pain and discomfort, were less often affected.…”

Microsurgical Management of Posterior Circulation Aneurysms: A Retrospective Study on Epidemiology, Outcomes, and Surgical Approaches

“…Further, the risk of epilepsy was greatly reduced. The endovascular treatment also showed an excellent quality-adjusted life years into the long-term follow-up [ 19 ]. Additionally, innovative endovascular techniques have continued to emerge, and the safety and efficacy of intracranial aneurysm treatment is improving [ 20 ].…”