Small intracranial aneurysms in the Barrow Ruptured Aneurysm Trial (BRAT)
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ANEURYSM
Small intracranial aneurysms in the Barrow Ruptured Aneurysm Trial (BRAT) Joshua S. Catapano 1 & Candice L. Nguyen 1 & Fabio A. Frisoli 1 & Soumya Sagar 1 & Jacob F. Baranoski 1 & Tyler S. Cole 1 & Mohamed A. Labib 1 & Alexander C. Whiting 1 & Andrew F. Ducruet 1 & Felipe C. Albuquerque 1 & Michael T. Lawton 1 Received: 25 August 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Treatment of small ruptured aneurysms (SRAs) remains controversial, with literature reporting difficulty with endovascular versus microsurgical approaches. This paper analyzes outcomes after endovascular coiling and microsurgical clipping among patients with SRAs prospectively enrolled in the Barrow Ruptured Aneurysm Trial (BRAT). Method All BRAT patients were included in this study. Patient demographics, aneurysm size, aneurysm characteristics, procedure-related complications, and outcomes at discharge and at 1-year and 6-year follow-up were evaluated. A modified Rankin scale (mRS) score > 2 was considered a poor outcome. Results Of 73 patients with SRAs, 40 were initially randomly assigned to endovascular coiling and 33 to microsurgical clipping. The rate of treatment crossover was significantly different between coiling and clipping; 25 patients who were assigned to coiling crossed over to clipping, and no clipping patients crossed over to coiling (P < 0.001). Among SRA patients, 15 underwent coiling and 58 underwent clipping; groups did not differ significantly in demographic characteristics or aneurysm type (P ≥ 0.11). Mean aneurysm diameter was significantly greater in the endovascular group (3.0 ± 0.3 vs 2.6 ± 0.6; P = 0.02). The incidence of procedure-related complications was similar for endovascular and microsurgical treatments (odds ratio [95% confidence interval], 1.0 [0.1–10.0], P = 0.98). Both groups had comparable overall outcome (mRS score > 2) at discharge and 1-year and 6-year follow-up (P = 0.48 and 0.73, respectively). Conclusions Most SRA patients in the BRAT underwent surgical clipping, with a high rate of crossover from endovascular approaches. Endovascular treatment was equivalent to surgical clipping with regard to procedure-related complications and neurologic outcomes. Keywords Endovascular coiling . Microsurgical clipping . Ruptured aneurysm . Small aneurysm
Abbreviations ACoA Anterior communication artery BRAT Barrow Ruptured Aneurysm Trial CTA Computed tomography angiography GCS Glasgow Coma Scale ICA Internal carotid artery
ISUIA mRS SRA
International Study of Unruptured Intracranial Aneurysms Modified Rankin Scale Small ruptured aneurysm
Introduction This article is part of the Topical Collection on Vascular Neurosurgery Aneurysm * Michael T. Lawton [email protected] 1
Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
Small intracranial aneurysms (≤ 3 mm maximum diameter) pose a challeng
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