Coiling v/s Clipping for cerebral aneurysms

The International Subarachnoid Aneurysm Trial (ISAT) was a multicenter, prospective, randomized controlled trial of endovascular coiling versus neurosurgical clipping in patients with ruptured cerebral aneurysms suitable for either therapy. This landmark study demonstrated superior one-year clinical outcomes associated with coiling. However, many proponents of clipping have criticized these results for the lack of longer-term follow-up, particularly as related to the durability of coiling for preventing rebleeding, and because of the need for and risks of surveillance angiography and possible retreatment. These latter concerns, combined with the expense of detachable coils, have also raised questions about the cost effectiveness of coiling, compared to clipping. Recent follow-up data from ISAT have addressed many of these issues, providing additional strong support for the superiority of endovascular coiling over neurosurgical clipping in the treatment of ruptured cerebral aneurysms having the favorable anatomy for either treatment.