{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T16:57:04Z","timestamp":1793465824650,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T00:00:00Z","timestamp":1540166400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Ruptured wide-neck aneurysms (WNAs) are difficult to treat and few publications have compared clipping to coiling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A post hoc analysis was conducted of saccular WNAs in the BRAT. A WNA was defined as maximum neck width\u00a0\u2265\u00a04 mm or maximum aneurysm dome-diameter\u2013to\u2013neck-width ratio\u00a0&lt;\u00a02. Both intent-to-treat and as-treated analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Of the 327 patients analyzed, 177 (54.1%) had a WNA. WNAs were more likely to occur in older patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.03) with worse presenting clinical grade (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.02), 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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.001) and were associated with worse clinical outcomes at all time points (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0\u2264\u00a0.01). WNAs were equally distributed in assigned treatment groups (clip 56.6% vs coil 51.8%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.38), but were overrepresented in the actual clipping group (clip 62.4% vs coil 37.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). 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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0\u2265\u00a0.33). The aneurysm obliteration rate was lower (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and the retreatment rate higher (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) in the actual coiling group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                    <jats:p\/>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyy439","type":"journal-article","created":{"date-parts":[[2018,8,22]],"date-time":"2018-08-22T15:18:53Z","timestamp":1534951133000},"page":"622-631","source":"Crossref","is-referenced-by-count":50,"title":["Analysis of Wide-Neck Aneurysms in the Barrow Ruptured Aneurysm Trial"],"prefix":"10.1227","volume":"85","author":[{"given":"Justin R","family":"Mascitelli","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T","family":"Lawton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin K","family":"Hendricks","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nakaji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M","family":"Zabramski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F","family":"Spetzler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,11]]},"reference":[{"issue":"9342","key":"bib1-20231012","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1016\/S0140-6736(02)11314-6","article-title":"International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial","volume":"360","author":"Molyneux","year":"2002","journal-title":"Lancet"},{"issue":"3","key":"bib2-20231012","doi-asserted-by":"crossref","first-page":"834","DOI":"10.3171\/2010.6.JNS091486","article-title":"Impact of International Subarachnoid Aneurysm Trial results on treatment of ruptured intracranial aneurysms in the United States. 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