In the surgical management of aneurysmal subarachnoid haemorrhage (SAH), the ISAT trial compared endovascular coiling versus neurosurgical clipping for ruptured intracranial aneurysms. The primary finding at 1 year was:
- A Clipping had superior 1-year independent survival and lower re-bleeding rate
- B Both modalities had equivalent survival and re-bleeding rates
- C Coiling had significantly better 1-year independent survival but higher long-term re-bleeding risk ✓
- D Coiling was only superior in posterior circulation aneurysms
Correct answer: C. Coiling had significantly better 1-year independent survival but higher long-term re-bleeding risk
Explanation
ISAT showed endovascular coiling significantly improved dependency-free survival at 1 year (23.7% vs 30.6% dead/dependent, absolute risk reduction 6.9%) compared to surgical clipping for ruptured aneurysms suitable for both treatments. Long-term follow-up showed a higher re-bleeding rate in the coiling group and late seizures were less common. Clipping remains preferred for young patients, complex middle cerebral artery aneurysms, and those with significant haematoma requiring evacuation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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