Death rate lower in coiled aneurysms at five years
07 April 2009
People who have a minimally invasive procedure to treat ruptured brain aneurysms are less likely to die than if they have open surgery, a study funded by the Medical Research Council has found.
The study compared coiling and clipping treatment methods in more than 2000 patients whose brain aneurysms had ruptured. A brain aneurysm occurs when the blood vessel wall weakens and causes swelling on the surface of the arteries running through the brain. The weakened wall can burst (or rupture) causing a brain haemorrhage.
Co-author Andrew Molyneux, from the Neurovascular and Neuroradiology Research Unit at John Radcliffe Hospital in Oxford, explained: “Coiling is a minimally invasive procedure involving a coil being inserted through the blood vessels into the aneurysm to seal the leak; clipping is an open surgical intervention where the aneurysm is clipped.
“We found people whose aneurysms were coiled had a 23% lower risk of dying within five years but the risk of rebleeding (a recurrence of the aneurysm rupturing) was slightly higher than people whose aneurysms were clipped.”
The research is published online and in the May edition of the Lancet Neurology journal.
The paper supports Dr Molyneux’s earlier work published in 2002 and 2005, also funded by the MRC, which suggested coiling was the best method for treating aneurysms. The 2002 paper resulted in a worldwide paradigm shift in treatment methods from clipping to coiling.
“Our earlier research showed fewer deaths and adverse effects at one year after the treatment. We were able to show the promising effects of coiling treatment in the short-term but the concern was that the effects of coiling would not be permanent,” Dr Molyneux said.
“This study has shown significantly more people were alive at five years after coiling treatment. While the risk of a further bleed was slightly greater in the coiled group, the risks in both groups were very low and did not outweigh the early clinical benefit.
“About 6000 people suffer from ruptured brain aneurysms in the UK each year. Hopefully our research will increase the shift in treatment methods from clipping to coiling and boost the numbers of people who go on to live healthy and fulfilling lives.
“These results represent the culmination of 14 years of research and the support of many patients. Our study demonstrates the importance of support, such as that provided by the Medical Research Council, for high quality clinical studies.”
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Notes:
Original paper: Large International Study shows clinical benefits of minimally invasive coiling of brain aneurysms after haemorrhage are maintained in the long-term published by The Lancet Neurology.
Related papers: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial published in 2002 by The Lancet.
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 published in 2005 by The Lancet.
