| Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). | |
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MedLine Citation:
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PMID: 17395870 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Because the long-term security of endovascular treatments remains uncertain, a follow-up study of the patients treated in the International Subarachnoid Aneurysm Trial was performed to compare the frequency, timing, and consequences of aneurysm recurrence. METHODS: Patient data were reclassified by actual treatment performed. Aneurysm and patient characteristics, including occlusion grades, time and type of retreatment, and clinical outcomes, were compared. The relationship between these variables and late retreatment as a surrogate for recurrence was analyzed by means of the Cox proportional hazards model. RESULTS: Retreatment was performed in 191 of 1096 (17.4%) patients after primary endovascular coiling (EVT) and in 39 of 1012 patients (3.8%) after neurosurgical clipping. After EVT, 97 (8.8%) patients were retreated early and 94 (9.0%) late, 7 (0.6%) after rebleeding and 87 (8.3%) without. The mean time to late retreatment was 20.7 months. After neurosurgical clipping, 30 (2.9%) patients were retreated early and 9 (0.85%) late, 3 (0.3%) after rebleeding and 6 (0.6%) without. The mean time to late retreatment was 5.7 months. The hazard ratio (HR) for retreatment after EVT was 6.9 (95% CI=3.4 to 14.1) after adjustment for age (P=0.001, HR=0.97, 95% CI=0.95 to 0.98), lumen size (P=0.006, HR=1.1, 95% CI=1.03 to 1.18), and incomplete occlusion (P<0.001, HR=7.6, 95% CI=3.3 to 17.5). CONCLUSIONS: Late retreatment was 6.9 times more likely after EVT. Younger age, larger lumen size, and incomplete occlusion were risk factors for late retreatment after EVT. After neurosurgical clipping, retreatments were earlier; whereas EVT retreatments continued to be performed throughout the follow-up period. Short-term follow-up imaging is therefore insufficient to detect recurrences after EVT. |
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Authors:
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Adriana Campi; Najib Ramzi; Andrew J Molyneux; Paul E Summers; Richard S C Kerr; Mary Sneade; Julia A Yarnold; Joan Rischmiller; James V Byrne |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2007-03-29 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 38 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-04-24 Completed Date: 2007-05-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1538-44 Citation Subset: IM |
Affiliation:
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Neurovascular Research Unit, Radcliffe Infirmary, University of Oxford, Oxford, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Aneurysm, Ruptured / epidemiology, therapy* Embolization, Therapeutic* Female Follow-Up Studies Humans Incidence Intracranial Aneurysm / epidemiology, therapy* Male Middle Aged Recurrence Reoperation Surgical Instruments Surgical Stapling* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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