Survival, Dependency, and Health-Related Quality of Life in Patients With Ruptured Intracranial Aneurysm: 10-Year Follow-up of the United Kingdom Cohort of the International Subarachnoid Aneurysm Trial

• Published in: Neurosurgery Vol. 88; no. 2; pp. 252 - 260
• Main Authors: Hua, Xinyang, Gray, Alastair, Wolstenholme, Jane, Clarke, Philip, Molyneux, Andrew J, Kerr, Richard S C, Clarke, Alison, Sneade, Mary, Rivero-Arias, Oliver
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.02.2021; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Aneurysm, Ruptured - surgery; Aneurysms; Care and treatment; Clinical outcomes; Clinical trials; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Epidemiology; Female; Follow-Up Studies; Hemorrhage; Humans; Intracranial Aneurysm - surgery; Intracranial aneurysms; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Patient outcomes; Patients; Quality of Life; Quality standards; Questionnaires; Research—Human—Clinical Trials; Stroke (Disease); Surveys and Questionnaires; Treatment Outcome; United Kingdom; Young Adult; United Kingdom; United Kingdom > UK; Endovascular coiling; Subarachnoid hemorrhage; Randomized controlled trail; Quality of life
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa454

Abstract BACKGROUND Previous analyses of the International Subarachnoid Aneurysm Trial (ISAT) cohort have reported on clinical outcomes after treatment of a ruptured intracranial aneurysm with either neurosurgical clipping or endovascular coiling. OBJECTIVE To evaluate the long-term quality-adjusted life years (QALYs) gained of endovascular coiling compare to neurosurgical clipping in the UK cohort of ISAT. METHODS Between September 12, 1994 and May 1, 2002, patients with ruptured intracranial aneurysms who were assumed treatment equipoise were randomly allocated to either neurosurgical clipping or endovascular coiling. We followed-up 1644 patients in 22 UK neurosurgical centers for a minimum of 10 yr. Health-related quality of life (HRQoL) was collected through yearly questionnaires, measured by utilities calculated from the EQ-5D-3L. We compared HRQoL between the 2 treatment groups over a period of 10 yr. In all, 1-yr, 5-yr, and 10-yr QALYs were estimated by combining utility and survival information. RESULTS Higher average utility values were found in the endovascular group throughout the follow-up period, with mean differences between groups statistically significant in most years. The 10-yr QALYs were estimated to be 6.68 (95% CI: 6.45-6.90) in the coiling group and 6.32 (95% CI: 6.10-6.55) in the clipping group, respectively, a significant mean difference of 0.36 (95% CI: 0.04-0.66). A third of this mean QALYs gain was estimated to derive solely from HRQoL differences. CONCLUSION HRQoL after treatment of a ruptured intracranial aneurysm was better after endovascular coiling compared to neurosurgical clipping, which contributed significantly to the QALYs gained over a 10-yr period. Graphical Abstract Graphical Abstract