{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:13:27Z","timestamp":1793394807211,"version":"4.5.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3]]},"abstract":"OBJECTIVE<\/jats:title>The authors present the 10-year results of the Barrow Ruptured Aneurysm Trial (BRAT) for saccular aneurysms. The 1-, 3-, and 6-year results of the trial have been previously reported, as have the 6-year results with respect to saccular aneurysms. This final report comparing the safety and efficacy of clipping versus coiling is limited to an analysis of those patients presenting with subarachnoid hemorrhage (SAH) from a ruptured saccular aneurysm.<\/jats:p><\/jats:sec>METHODS<\/jats:title>In the study, 362 patients had saccular aneurysms and were randomized equally to the clipping and the coiling cohorts (181 each). The primary outcome analysis was based on the assigned treatment group; poor outcome was defined as a modified Rankin Scale (mRS) score > 2 and was independently adjudicated. The extent of aneurysm obliteration was adjudicated by a nontreating neuroradiologist.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>There was no statistically significant difference in poor outcome (mRS score > 2) or deaths between these 2 treatment arms during the 10 years of follow-up. Of 178 clip-assigned patients with saccular aneurysms, 1 (< 1%) was crossed over to coiling, and 64 (36%) of the 178 coil-assigned patients were crossed over to clipping. After the initial hospitalization, 2 of 241 (0.8%) clipped saccular aneurysms and 23 of 115 (20%) coiled saccular aneurysms required retreatment (p < 0.001). At the 10-year follow-up, 93% (50\/54) of the clipped aneurysms were completely obliterated, compared with only 22% (5\/23) of the coiled aneurysms (p < 0.001). Two patients had documented rebleeding, both died, and both were in the assigned and treated coiled cohort (2\/83); no patient in the clipped cohort (0\/175) died (p = 0.04). In 1 of these 2 patients, the hemorrhage was not from the target aneurysm but from an incidental basilar artery aneurysm, which was coiled at the same time.<\/jats:p><\/jats:sec>CONCLUSIONS<\/jats:title>There was no significant difference in clinical outcomes between the 2 assigned treatment groups as measured by mRS outcomes or deaths. Clinical outcomes in the patients with posterior circulation aneurysms were better in the coiling group at 1 year, but after 1 year this difference was no longer statistically significant. Rates of complete aneurysm obliteration and rates of retreatment favored patients who actually underwent clipping compared with those who underwent coiling.<\/jats:p>Clinical trial registration no.: NCT01593267 (clinicaltrials.gov)<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.8.jns181846","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T19:59:20Z","timestamp":1554839960000},"page":"771-776","source":"Crossref","is-referenced-by-count":134,"title":["Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial"],"prefix":"10.3171","volume":"132","author":[{"given":"Robert F.","family":"Spetzler","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron G.","family":"McDougall","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Zabramski","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe C.","family":"Albuquerque","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy K.","family":"Hills","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"},{"name":"Epidemiology and Biostatistics, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nakaji","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Karis","sequence":"additional","affiliation":[{"name":"Neuroradiology, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Wallace","sequence":"additional","affiliation":[{"name":"Neuroradiology, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/S0090-3019(03)00097-1","article-title":"ISAT study: is coiling better than clipping? 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