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Friday, 25 October, 2002, 00:27 GMT 01:27 UK
Treatment cuts brain injury deaths
Brain image
Traditionally, patients had invasive brain surgery
Doctors have halted the trial of a treatment for brain injury after it was shown to cut the risk of death and disability by 25%.

The treatment, for patients who have suffered a burst blood vessel in the brain, does not require invasive surgery.

The trial was designed to compare this technique with the traditional treatment which involves neurosurgery.

But doctors decided it would be wrong to carry on the trial after results proved conclusively that the new treatment offered such significant advantages.

The international study looked at patients in centres in Europe, Australia and North America.


For many patients this could mean the difference between a return to normal life or substantial disability

Mr Richard Kerr, Radcliffe Infirmary, Oxford
The 2,000 patients who took part in the study before it was stopped in May, had suffered burst blood vessels, or aneurysms, in the brain.

It was originally intended that 3,000 patients should be studied.

Aneurysms are a swelling of a blood vessel, where part of the vein or artery inflates like a balloon making it thinner and weaker than other parts of the vessel.

They can lie dormant for years without causing problems but can also rupture without warning, potentially causing strokes.

Reduced risk

A subarachnoid haemorrhage is bleeding onto the surface of the brain, most often caused by a break in a blood vessel at the base of the brain.

Around eight in 100,000 people in western countries have a subarachnoid haemorrhage each year.

Graphic - (C) Mayfield Clinic
The traditional clip treatment
A third die within 24 hours, and others are left severely disabled.

The traditional treatment for a burst aneurysm is to open the skull and place a metal clip across the neck of the aneurysm to stop it bleeding.

In the newer treatment, which proved more effective, a catheter is inserted through an artery in the leg up into the brain to fill the aneurism there with tiny platinum coils.

Graphic - (C) Mayfield Clinic
The coil reduces the risk of disability
Data from just under 1,600 patients showed that after a year 23.7% of those who had the coil treatment were dead or disabled compared to 30.6% of those who had undergone neurosurgery - a relative risk reduction of just under a quarter.

'Groundbreaking'

Mr Richard Kerr is a consultant neurosurgeon from the Radcliffe Infirmary in Oxford, and one of the researchers leading the International Subarachnoid Aneurysm Trial (ISAT).

He said: "What this means for patients in the future is that, potentially, out of every 100 patients treated, around seven could expect to be better off one year on if they received endovascular treatment rather than conventional surgery.

"For many patients this could mean the difference between a return to normal life or substantial disability."

The research, funded by the Medical Research Council, provides doctors with evidence as to which technique they should use.


It's possible that there are patients who would not be offered coiling as the first choice procedure, when perhaps they should

Dr Richard Nelson, Frenchay Hospital, Bristol
At the moment, there is wide variation in the use of the coil technique, with high use in countries including the UK and France, and low use in the USA and Germany.

Dr Andrew Molyneux, a consultant neuroradiologist at the Radcliffe, said: "This trial really has produced a groundbreaking result that will change medical practice."

He said some patients would still need surgery, but added coiling should be suitable for eight out of 10 people who suffered a subarachnoid haemorrhage from an aneurysm.

'Devastating effects'

Dr Richard Nelson, a consultant neurosurgeon at Frenchay Hospital in Bristol, told the BBC the study's findings should mean all patients got the same treatment.

"It's possible that there are patients who would not be offered coiling as the first choice procedure, when perhaps they should.

"That's inevitable. We've only just had the results of this study. People have to look at these results and look at how the service will be developed as a result."

The research is published in The Lancet.

More work will be done to look at the cost effectiveness of coiling and surgery, and to look at how patients have fared five years after the operation.

The Stroke Association is also looking at whether neurological behaviour results are better with the coil treatment.

See also:

23 Jun 00 | G-I
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