The ISAT trial compared endovascular coiling to neurosurgical clipping for ruptured intracranial aneurysms. Its primary finding at 1 year was:
- A Coiling significantly reduced death or dependency (mRS ≥3) at 1 year compared to clipping ✓
- B Clipping was superior in preventing rebleeding over 10 years
- C Coiling was associated with greater risk of long-term epilepsy
- D No significant difference in clinical outcome between coiling and clipping at 1 year
Correct answer: A. Coiling significantly reduced death or dependency (mRS ≥3) at 1 year compared to clipping
Explanation
The ISAT trial demonstrated that endovascular coiling significantly reduced the proportion of patients dead or dependent (modified Rankin Scale ≥3) at 1 year compared to neurosurgical clipping (23.7% vs 30.6%), an absolute risk reduction of 6.9%. However, long-term follow-up showed higher rates of late rebleeding with coiling and increased retreatment rates. Consequently, coiling is preferred for anatomically suitable aneurysms in most centers, but clipping remains superior for complete and durable occlusion, particularly in younger patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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