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Proceedings of the 144th Meeting of the Society of British Neurological Surgeons, held jointly with the Brazilian Neurosurgical Society

Introduction: The first results from the International Subarachnoid Aneurysm Trial (ISAT) were published in the Lancet in October 2002. Methods: ISAT is a multicentre randomized controlled trial (RCT) comparing the policies of endovascular versus neurosurgical treatments of aneurysmal subarachnoid haemorrhage (SAH) in an eligible population. Patients were considered suitable for randomization if there was uncertainty as to which was the best method of treatment. Neurological outcome was measured at 2 months and 1 year postrandomization using the modified Rankin Scale. Neuropsychological outcome was measured at 3 months and 1 year in certain centres in the UK. There were 2143 patients entered into the trial from 43 centres. ISAT ceased recruitment in May 2002. Results: One year data have now been analysed in all patients. Results demonstrate a significant reduction in both relative and absolute risk in patients who were randomized to an endovascular treatment policy. These results have had a profound effect on the treatment of patients with SAH in certain areas of the world. Conclusion: This paper describes the full 1 year results together with new data on epilepsy, as well as health economic data. It also discusses the impact that the results have already had on the management of patients with aneurysmal subarachnoid haemorrhage and the treatments offered to them.