TY - JOUR
T1 - Analysis of Wide-Neck Aneurysms in the Barrow Ruptured Aneurysm Trial
AU - Mascitelli, Justin R.
AU - Lawton, Michael T.
AU - Hendricks, Benjamin K.
AU - Nakaji, Peter
AU - Zabramski, Joseph M.
AU - Spetzler, Robert F.
N1 - Funding Information:
The Barrow Ruptured Aneurysm Trial was funded by the Barrow Neurological Foundation and the Hanley Aneurysm Fund. Dr Mascitelli and Dr Lawton are conducting a multicenter registry of WNAs, which is unrelated to the present review. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
Copyright © 2018 by the Congress of Neurological Surgeons.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - BACKGROUND: Ruptured wide-neck aneurysms (WNAs) are difficult to treat and few publications have compared clipping to coiling. OBJECTIVE: To determine, using Barrow Ruptured Aneurysm Trial (BRAT) data: (1) How many aneurysms had a wide neck? (2) Did wide-neck status influence treatment? (3) How did clipping compare to coiling for WNAs? METHODS: A post hoc analysis was conducted of saccular WNAs in the BRAT. A WNA was defined as maximum neck width ≥ 4 mm or maximum aneurysm dome-diameter-to-neck-width ratio < 2. Both intent-to-treat and as-treated analyses were performed. RESULTS: Of the 327 patients analyzed, 177 (54.1%) had a WNA. WNAs were more likely to occur in older patients (P =. 03) with worse presenting clinical grade (P =. 02), were more likely to arise from the middle cerebral artery, basilar tip, or internal carotid artery other than the junction with the posterior communicating artery (P =. 001) and were associated with worse clinical outcomes at all time points (P ≤. 01). WNAs were equally distributed in assigned treatment groups (clip 56.6% vs coil 51.8%; P =. 38), but were overrepresented in the actual clipping group (clip 62.4% vs coil 37.6%, P <. 001). Most patients (76.7%) in the coil-to-clip crossover group had a WNA. Comparing clipping to coiling, there was no difference in clinical outcomes at any time point in either analysis (P ≥. 33). The aneurysm obliteration rate was lower (P <. 001) and the retreatment rate higher (P <. 001) in the actual coiling group. CONCLUSION: Wide-neck status significantly impacted treatment strategy in the BRAT, favoring clipping. Clipping and coiling of ruptured WNAs resulted in statistically similar long-term clinical outcomes. 10.1093/neuros/nyy439 Video Abstract 10.1093.neuros.nyy439 5850292551001
AB - BACKGROUND: Ruptured wide-neck aneurysms (WNAs) are difficult to treat and few publications have compared clipping to coiling. OBJECTIVE: To determine, using Barrow Ruptured Aneurysm Trial (BRAT) data: (1) How many aneurysms had a wide neck? (2) Did wide-neck status influence treatment? (3) How did clipping compare to coiling for WNAs? METHODS: A post hoc analysis was conducted of saccular WNAs in the BRAT. A WNA was defined as maximum neck width ≥ 4 mm or maximum aneurysm dome-diameter-to-neck-width ratio < 2. Both intent-to-treat and as-treated analyses were performed. RESULTS: Of the 327 patients analyzed, 177 (54.1%) had a WNA. WNAs were more likely to occur in older patients (P =. 03) with worse presenting clinical grade (P =. 02), were more likely to arise from the middle cerebral artery, basilar tip, or internal carotid artery other than the junction with the posterior communicating artery (P =. 001) and were associated with worse clinical outcomes at all time points (P ≤. 01). WNAs were equally distributed in assigned treatment groups (clip 56.6% vs coil 51.8%; P =. 38), but were overrepresented in the actual clipping group (clip 62.4% vs coil 37.6%, P <. 001). Most patients (76.7%) in the coil-to-clip crossover group had a WNA. Comparing clipping to coiling, there was no difference in clinical outcomes at any time point in either analysis (P ≥. 33). The aneurysm obliteration rate was lower (P <. 001) and the retreatment rate higher (P <. 001) in the actual coiling group. CONCLUSION: Wide-neck status significantly impacted treatment strategy in the BRAT, favoring clipping. Clipping and coiling of ruptured WNAs resulted in statistically similar long-term clinical outcomes. 10.1093/neuros/nyy439 Video Abstract 10.1093.neuros.nyy439 5850292551001
KW - Aneurysm
KW - Barrow Ruptured Aneurysm Trial, Wide neck
UR - http://www.scopus.com/inward/record.url?scp=85074785966&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074785966&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyy439
DO - 10.1093/neuros/nyy439
M3 - Article
C2 - 30346618
AN - SCOPUS:85074785966
SN - 0148-396X
VL - 85
SP - 622
EP - 631
JO - Clinical Neurosurgery
JF - Clinical Neurosurgery
IS - 5
ER -