PT - JOURNAL ARTICLE AU - Tim E Darsaut AU - J Max Findlay AU - Elsa Magro AU - Marc Kotowski AU - Daniel Roy AU - Alain Weill AU - Michel W Bojanowski AU - Chiraz Chaalala AU - Daniela Iancu AU - Howard Lesiuk AU - John Sinclair AU - Felix Scholtes AU - Didier Martin AU - Michael M Chow AU - Cian J O’Kelly AU - John H Wong AU - Ken Butcher AU - Allan J Fox AU - Adam S Arthur AU - Francois Guilbert AU - Lu Tian AU - Miguel Chagnon AU - Suzanne Nolet AU - Guylaine Gevry AU - Jean Raymond TI - Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomised trial AID - 10.1136/jnnp-2016-315433 DP - 2017 Aug 01 TA - Journal of Neurology, Neurosurgery & Psychiatry PG - 663--668 VI - 88 IP - 8 4099 - http://jnnp.bmj.com/content/88/8/663.short 4100 - http://jnnp.bmj.com/content/88/8/663.full SO - J Neurol Neurosurg Psychiatry2017 Aug 01; 88 AB - Background Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed and are commonly treated using endovascular treatment or microsurgical clipping. The safety and efficacy of treatments have not been compared in a randomised trial. How to treat patients with UIAs suitable for both options remains unknown.Methods We randomly allocated clipping or coiling to patients with one or more 3–25 mm UIAs judged treatable both ways. The primary outcome was treatment failure, defined as: initial failure of aneurysm treatment, intracranial haemorrhage or residual aneurysm on 1-year imaging. Secondary outcomes included neurological deficits following treatment, hospitalisation >5 days, overall morbidity and mortality and angiographic results at 1 year.Results The trial was designed to include 260 patients. An analysis was performed for slow accrual: 136 patients were enrolled from 2010 through 2016 and 134 patients were treated. The 1-year primary outcome, available for 104 patients, was reached in 5/48 (10.4% (4.5%–22.2%)) patients allocated surgical clipping, and 10/56 (17.9% (10.0%–29.8%)) patients allocated endovascular coiling (OR: 0.54 (0.13–1.90), p=0.40). Morbidity and mortality (modified Rankin Scale>2) at 1 year occurred in 2/48 (4.2% (1.2%–14.0%)) and 2/56 (3.6% (1.0%–12.1%)) patients allocated clipping and coiling, respectively. New neurological deficits (15/65 vs 6/69; OR: 3.12 (1.05–10.57), p=0.031), and hospitalisations beyond 5 days (30/65 vs 6/69; OR: 8.85 (3.22–28.59), p=0.0001) were more frequent after clipping.Conclusion Surgical clipping or endovascular coiling of UIAs did not show differences in morbidity at 1 year. Trial continuation and additional randomised evidence will be necessary to establish the supposed superior efficacy of clipping.