Vermeulen M, Bosch D A, van Rooij W J J
Afd. Neurologie, Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
Ned Tijdschr Geneeskd. 2003 Mar 15;147(11):477-9.
In the 'International subarachnoid aneurysm trial' (ISAT), patients with ruptured intracranial aneurysms were randomised to endovascular detachable coil treatment or craniotomy with clipping of the aneurysm if either treatment was judged to be suitable. Of all patients assessed for eligibility, endovascular treatment was considered the best treatment for 29% and neurosurgical clipping was considered best for 38%, in 11% the treatment was unknown, which left 22% for whom there was no preference for one of the two treatments and who gave permission for randomisation. In patients allocated endovascular treatment, 24% was dependent or dead at 1 year versus 31% of patients allocated neurosurgical treatment. The relative-risk reduction in dependency or death at 1 year was 23%. The risk of re-bleeding after 1 year was 2 per 1276 patient years in patients allocated endovascular treatment and 0 per 1081 patient years in those allocated neurosurgical treatment. Based on these results it is estimated that in the Netherlands each year at least 500 patients with a ruptured intracranial aneurysm should be treated with endovascular coiling within 3 days of the haemorrhage. This treatment can best be limited to a few centres, since it will otherwise not be possible to gain sufficient experience. The same applies to neurosurgical treatment since the number of patients treated with neurosurgical clipping will decrease.
在“国际蛛网膜下腔动脉瘤试验”（ISAT）中，颅内动脉瘤破裂患者被随机分配接受血管内可脱性弹簧圈治疗或开颅夹闭动脉瘤，前提是两种治疗方法都被判定为合适。在所有评估是否符合条件的患者中，29%的患者被认为血管内治疗是最佳治疗方法，38%的患者被认为神经外科夹闭是最佳治疗方法，11%的患者治疗方法未知，剩下22%的患者对两种治疗方法无偏好并同意随机分组。接受血管内治疗的患者中，1年后有24%出现依赖或死亡，而接受神经外科治疗的患者这一比例为31%。1年后依赖或死亡的相对风险降低了23%。接受血管内治疗的患者每1276患者年有2例1年后再出血，接受神经外科治疗的患者每1081患者年为0例。基于这些结果，据估计在荷兰每年至少有500例颅内动脉瘤破裂患者应在出血后3天内接受血管内弹簧圈栓塞治疗。这种治疗最好限于少数几个中心，否则将无法获得足够的经验。神经外科治疗也是如此，因为接受神经外科夹闭治疗的患者数量将会减少。
