gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

The impact of the International Subarachnoid Aneurysm Trial (ISAT) on the clinical management of patients with aneurysms and aneurysmal subarachnoid hemorrhage: A single neurovascular centre experience

Management von Aneurysmapatienten nach der ISAT-Studie: Erfahrungen eines neurovaskulären Zentrums

Meeting Abstract

  • corresponding author V. Seifert - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • A. Raabe - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • J. Beck - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • M. Setzer - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • A. Woszczyk - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • H. Vatter - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • R. Gerlach - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • R. du Mesnil de Rochemont - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • J. Berkefeld - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-13.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0150.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Seifert et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

To analyze the changes in the clinical management of patients with aneurysms and aneurysmal subarachnoid hemorrhage after publication of the results of the International Subarachnoid Aneurysm Trial (ISAT) in a single neurovascular centre over a period of 5 years.

Methods

Patients with aneurysms and aneurysmal subarachnoid hemorrhage treated at a single institution, where both modalities of clipping and coiling are available 24 hours a day.

Results

Over a period of 5 years from January 2000 to December 2004, 540 patients with 677 cerebral aneurysms were seen at our institution. Of these patients, 435 patients (80,5%) were treated with either microsurgical operation or endovascular coiling. Over the 3 years period from 2000 to 2002 the percentage of clipping to coiling was almost identical=(2000: clipping 66%, coiling 34%; 2001: clipping 71 %, coiling 29%; 2002: clipping 71%, coiling 29%). After publication of the final ISAT results in October 2002 a definitive change in the clinical management of SAH patients occured with a considerable increase in the percentage of patients being coiled. This is clearly reflected by analyzing the data of patient treatment in the two years since publication of the ISAT results=(2003: clipping 53%, coiling 47%, 2004: clipping 42%, coiling 58%). In summarizing these data a radical change has occurred from 69.3% clipping and 30.7% coiling in the period from 2000 to 2002 prior to ISAT to 47.5 % clipping and 52.5% coiling in the period after ISAT from 2003 to 2004. The final results whether the change in the management modality has also had an impact on the overall outcome of SAH patients can not be answered at the time of abstract presentation, but will be included into the final analyzes of this study and presented.

Conclusions

The data presented here clearly show a definitive change in the patient management since publication of the ISAT study, which more than reversed the percentage of patients being clipped to those being coiled from the year 2003 on. The radicality of the change can also be demonstrated by the fact that from 2002 to 2003 the number of patients being clipped fell from 71% to 53%, reflected by an increase in coiled patients from 29% to 47%. In can be assumed, that these changes, which are exemplary demonstrated here by the experiences of a large volume aneurysm centre, will have a dramatic impact on the future treatment of aneurysm patients in regard to surgical volume, surgical experience, training and reimbursement.