Coils slash death/disabilty from brain aneurysms

Preliminary results of a long-term study suggest that coils inserted into burst aneurysms in the brain decrease by 25 percent the risk of patient death and disability during the first year after the procedure, according to a report published in the October 26 issue of The Lancet. Aneurysms are abnormal ballooning of artery walls.

"The results with coiling were so favorable the trial was ended ahead of schedule," says Kieran Murphy, M.D., the primary investigator for the study at Hopkins and associate professor of radiology and neurological surgery.

The study, called the International Subarachnoid Aneurysm Trial (ISAT), examined patients at 44 medical centers in Europe, Australia and North America whose aneurysms were suitable for treatment with either surgical clipping or coiling. Those with aneurysms shaped in such a manner that prevented the retention of the coils as well as those for whom surgical clipping was not possible, were excluded from the study. Of 2,143 patients for whom both treatments were appropriate, 1,073 were randomly selected to receive the coils, and 1,070 were chosen to undergo surgical clipping.

Surgical clipping, currently the most commonly used treatment for brain aneurysms, requires opening the skull and placing a metal clip across the neck of the aneurysm to stop the bleeding. In coiling, a catheter is inserted through an artery in the leg up into the brain to fill the aneurysm there with tiny platinum coils.

The coils are like "miniature slinkies that are folded gently into the aneurysm like a ball of yarn one by one to stop the bleeding," says Murphy. Noting that the procedure also can be used to prevent aneurysms from bursting, he adds, "With coiling, we can either help fix the damage or prevent it from occurring."

Murphy likens brain aneurysms to ticking time bombs. "They can lurk for years without causing symptoms. Then, without warning, they can burst, spilling blood into the brain wit

Contact: Gary Stephenson
Johns Hopkins Medical Institutions

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