The ISAT trial (International Subarachnoid Aneurysm Trial) compared endovascular coiling to neurosurgical clipping for ruptured intracranial aneurysms. The primary outcome at 1 year showed:
- A Surgical clipping had lower rate of re-bleeding with equivalent functional outcome
- B Endovascular coiling had significantly better functional outcome (lower rate of dependency or death) ✓
- C Both treatments had equivalent functional outcomes with higher re-bleeding in coiling
- D Coiling was superior only for posterior circulation aneurysms
Correct answer: B. Endovascular coiling had significantly better functional outcome (lower rate of dependency or death)
Explanation
ISAT demonstrated that endovascular coiling achieved significantly better functional outcome at 1 year compared to neurosurgical clipping: relative risk reduction of 22.6% in death or dependence (7.4% absolute risk reduction). Coiling was associated with a higher risk of late re-bleeding but significantly lower peri-procedural morbidity. It established coiling as the preferred first-line treatment for suitable ruptured aneurysms.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.