LONDON (AP) - Many patients with brain aneurysms are less likely to die or become severely disabled if they are treated with a coil threaded through the blood vessels instead of surgery, new research suggests.
An aneurysm is a bulge in the wall of a blood vessel. If it breaks open, it bleeds into the brain. About half of patients with ruptured aneurysms die. Sometimes, an aneurysm can open, bleed a little and heal, but is in danger of bursting again.
In the United States, patients are most often treated with brain surgery to prevent another hemorrhage, but in Europe the coil technique is more popular.
The new study, the first major trial comparing the two approaches, found patients who got the coils were 23 percent less likely than the surgical patients to die or become seriously disabled within the year after their operations. It was done by Oxford University scientists.
Some experts predict the findings, published this week in The Lancet medical journal, will change the way many brain aneurysm patients are treated, particularly in the United States.
But others are not so convinced.
Dr. Denis Clement, a spokesman for the European Society of Cardiology, urged caution. "This whole endovascular area is moving so quickly that you never know whether another study in a few months will come out with opposite results," he said.
The surgery involves opening the skull and placing a tiny clip on the neck of the aneurysm to prevent more blood from reaching it. The surgeon then sometimes pops the bubble. The clip is left in.
With the coil, a radiologist pierces an artery, usually in the groin, and threads a tube through the blood vessels with the help of an X-ray showing the route and the location of the aneurysm.
The tube contains a tiny platinum coil that is ejected into the aneurysm, which is on one side of the blood vessel. Several more coils are inserted until the bubble is packed full. The idea is to block the path so blood is forced to flow past the bulge.
The study involved 1,594 patients with ruptured brain aneurysms in European hospitals. Half were randomly assigned to get surgery and half to have coil treatment. A year later, 24 percent of the coil patients had died or become disabled, compared with 31 percent of those who had surgery.
The aneurysms of those who got the coil were more likely to start bleeding again than those of the surgical patients.
"But that's offset by fewer patients being damaged by surgery," said one of the study's lead investigators, Dr. Andrew Molyneux.
Dr. Demetrius Lopes, a surgeon at Rush-Presbyterian-St. Luke's Medical Center in Chicago who uses both techniques, said the study would be an eye opener to many American doctors.
"It shows that the coils, or endovascular therapies, should be offered to every patient that has a cerebral hemorrhage," he said. "Both techniques have to be available to the patients."
Dr. Christopher Ogilvy, director of neurovascular surgery at Massachusetts General Hospital and a professor at Harvard Medical School, was not so impressed.
"It looks like there's a statistical difference, but is there really a biologic difference?" he said.
He noted that when disability and death were compared separately, the key measurements - serious restriction in lifestyle, partial disability, full dependence on others and death - were not significantly different between the two treatments.
Nevertheless, Dr. Marc Mayberg, chairman of neurosurgery at the Cleveland Clinic and a spokesman for the American Stroke Association, said the British trial could prompt changes in the United States.
"Patients with an aneurysm really need to be evaluated in a center that offers both kinds of treatment, in a truly unbiased setting where their aneurysm is evaluated by experts," said Mayberg, who wrote the current American Stroke Association guidelines.
The study was funded by Britain's Medical Research Council.
On the Net:
Brain Aneurysm Foundation: http://www.bafound.org/index.htm
Aneurysm and AVM support site: http://www.westga.edu/7/8wmaples/brain.html