SNIS 2019: Large scale endovascular treatment has improved outcomes for patients with ruptured brain aneurysms


Andrew Molyneux (Oxford, UK) spoke to BLearning following his luminary lecture at SNIS 2019 (22–25 July, Miami, USA) titled, “Reflections on 30 years of cerebral aneurysm treatment: The impact of the ISAT trial.”

Molyneux explained that the International Subarachnoid Aneurysm Trial (ISAT) which began in 1994 was halted in 2002 after interim analysis found that the coiling “was significantly safer” than clipping and more patients were alive and independent at one year.

Following the announcement of the results, in the UK there was “an immediate change in practice” which resulted in around 90% of patients receiving the endovascular treatment – up from around the 25% mark seen prior to the ISAT trial. Molyneux notes that the 10-year follow-up of the UK patients in the trial has shown that the clinical benefit observed at one year has also been maintained at 10 years.

There is going to “continue to be evolution in terms of the devices”, he says, adding however that “coiling and other intrasaccular devices will remain the mainstay of treatment over the next five to 10 years”.


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