Endovascular coil superior to neurosurgery for treatment of brain haemorrhage

October 24, 2002

Results of a landmark international study in this week's issue of THE LANCET provide compelling evidence for the use of a platinum coil transported through blood vessels--rather than conventional neurosurgery--to stop bleeding after brain haemorrhage.

Around 8 in 100,000 people in western countries have a subarachnoid haemorrhage (the bursting of a blood vessel in the brain) every year; around 30% of people die within 24 hours of haemorrhage, and conventional neurosurgical 'clipping' to prevent further rupture of the blood vessels is a high-risk, invasive procedure. The use of endovascular coils--a less invasive option, where a platinum coil is guided through an artery to the weakened vessel in the brain to stop bleeding--has emerged as a new treatment option over the past decade. The International Subarachnoid Aneurysm Trial (ISAT) investigators, led by Andrew Molyneux and Richard Kerr from The Radcliffe Infirmary, Oxford, UK, compared the safety and efficacy of endovascular coiling with standard neurosurgical clipping.

2143 patients from 43 neurosurgical centres in Europe, Australia, and North America were randomly assigned to neurosurgical clipping or endovascular platinum coil treatment. 23.7% (190) patients given endovascular treatment were disabled or dead at 1 year compared with 30.6% (243 patients) who received neurosurgery--a relative reduction in risk of dependency or death approaching 25%, and an absolute reduction of around 7%.

Andrew Molyneux comments: "The results presented here indicate that, for patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coil therapy is significantly more likely to result in survival free of disability 1 year after the subarachnoid haemorrhage than neurosurgical treatment. Longer-term follow up, however, is vital to answer the question of durability of benefit."

In an accompanying Commentary (p 1262), Douglas A Nichols from the Mayo Clinic, USA, and colleagues conclude: "The ISAT investigators are to be congratulated for addressing an important clinical dilemma in a meticulous randomised trial. The study suggests that the small subgroup of good-grade, anterior circulation, small ruptured saccular aneurysms, of such morphology that they would be considered a reasonable candidate for neurosurgical or endovascular therapy, should be considered for coiling if such expertise is available on an emergency basis. However, these data cannot be extrapolated to all other ruptured aneurysms, or to the entire population of unruptured aneurysms."
Contact: Margaret Willson (media officer);
T) 44-153-677-2181;
M) 44-797-385-3347;
E) m.willson@mwcommunications.org.uk

Dr Douglas A Nichols, c/o Mary Lawson, Mayo Clinic Communications Department;
T) 507 266 0810;
E) Lawson.mary18@mayo.edu


Related Brain Articles from Brightsurf:

Glioblastoma nanomedicine crosses into brain in mice, eradicates recurring brain cancer
A new synthetic protein nanoparticle capable of slipping past the nearly impermeable blood-brain barrier in mice could deliver cancer-killing drugs directly to malignant brain tumors, new research from the University of Michigan shows.

Children with asymptomatic brain bleeds as newborns show normal brain development at age 2
A study by UNC researchers finds that neurodevelopmental scores and gray matter volumes at age two years did not differ between children who had MRI-confirmed asymptomatic subdural hemorrhages when they were neonates, compared to children with no history of subdural hemorrhage.

New model of human brain 'conversations' could inform research on brain disease, cognition
A team of Indiana University neuroscientists has built a new model of human brain networks that sheds light on how the brain functions.

Human brain size gene triggers bigger brain in monkeys
Dresden and Japanese researchers show that a human-specific gene causes a larger neocortex in the common marmoset, a non-human primate.

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.

An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.

Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.

Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.

Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.

Read More: Brain News and Brain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.