神经外科夹闭和血管内弹簧圈栓塞治疗2143例颅内动脉瘤破裂患者的国际蛛网膜下腔动脉瘤试验(ISAT):一项对生存情况、依赖性、癫痫发作、再出血、亚组和动脉瘤阻塞影响的随机对比试验  

International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and

作　　者：Molyneux A.J. Kerr R.S. 郭俊 

机构地区：[1]Nuffield Department of Surgery, University of Oxford, Oxford Radcliffe Hospitals, Oxford, United Kingdom

出　　处：《世界核心医学期刊文摘（神经病学分册）》2006年第3期4-4,共1页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.

关 键 词：膜下腔 神经外科 再出血 ISAT 弹簧圈栓塞 生存情况 亚组 对比试验 预后指标 发病风险 

分 类 号：R739.4[医药卫生—肿瘤]