Article Summary

BRAT (Barrow Ruptured Aneurysm Trial)

Cameron G. McDougall, M.D., Robert F. Spetzler, M.D., Joseph M. Zabramski, M.D., Shahram Partovi, M.D.,,Nancy K. Hills, Ph.D., Peter Nakaji, M.D., and Felipe C. Albuquerque, M.D
Journal of Neurosurgery Jan 2012; Vol. 116; No. 1; 135-144.

Object: The purpose of this ongoing study is to compare the safety and efficacy of microsurgical clipping and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to determine if one treatment is superior to the other by examining clinical and angiographic outcomes.

Methods: The authors screened 725 patients with subarachnoid hemorrhage (SAH), resulting in 500 eligible patients who were enrolled prospectively in the study after giving their informed consent. Patients were assigned in an alternating fashion to surgical aneurysm clipping or endovascular coil therapy.

Results: A poor outcome (mRS score > 2) was observed in 33.7% of the patients assigned to aneurysm clipping and in 23.2% of the patients assigned to coil embolization (OR 1.68, 95% CI 1.08–2.61; p = 0.02).  No patient treated by coil embolization suffered a recurrent hemorrhage.

Conclusions: One year after treatment, a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes than clip occlusion.

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