• Mohsen Javadpour, Harsh Jain, M Christopher Wallace, Robert A Willinsky, Karel G ter Brugge, and Michael Tymianski.
• University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Toronto, Ontario, Canada.
• Neurosurgery. 2005 May 1; 56 (5): 886-94; discussion 886-94.

ObjectiveThe goal of this study was to compare, in a North American setting, the cost-effectiveness of neurosurgical clipping versus endovascular coiling treatment of ruptured intracranial aneurysms. A secondary goal was to assess the clinical outcomes of patients enrolled into the International Subarachnoid Aneurysm Trial (ISAT) from the largest contributing North American center.MethodsOf 230 patients with ruptured intracranial aneurysms, 62 were randomized into ISAT at our institution. Of these, 30 were randomized to endovascular coiling and 32 to neurosurgical clipping. For these, we evaluated the costs of treatment related to all aspects of the inpatient stay, the clinical outcomes at 2 months and at 1 year using the modified Rankin Scale, and the radiological outcomes at 6 months after Guglielmi detachable coiling.ResultsThere were no significant differences in the total cost of treatment between the endovascular group and the neurosurgical clipping group. The benefits of apparent decrease in length of stay in the endovascular group were offset by higher procedure costs. There were no significant differences in clinical outcomes at 2 months and at 1 year. At 6 months after coiling, 15 (50%) of 30 aneurysms were completely obliterated, and 19 (63%) of 30 were angiographically stable.ConclusionThe high procedure costs of endovascular coiling tended to offset apparent reductions in length of stay. Long-term follow-up is indicated both for costs incurred after initial treatment and for clinical outcome in patients with incompletely obliterated aneurysms.

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