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Joshua S. Catapano, Mohamed A. Labib, Visish M. Srinivasan, Candice L. Nguyen, Kavelin Rumalla, Redi Rahmani, Tyler S. Cole, Jacob F. Baranoski, Caleb Rutledge, Kristina M. Chapple, Andrew F. Ducruet, Felipe C. Albuquerque, Joseph M. Zabramski, and Michael T. Lawton

T he Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial comparing endovascular embolization (coiling) to microsurgical clipping for treatment of patients experiencing aneurysmal subarachnoid hemorrhage (aSAH). 1 – 5 At long-term follow-up, the neurological outcome did not differ for patients with saccular aneurysms treated endovascularly and those treated microsurgically, but rates of retreatment were significantly higher in patients with endovascular treatment. 1 , 2 However, results from the BRAT have been heavily criticized because of a

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Joshua S. Catapano, Mohamed A. Labib, Fabio A. Frisoli, Megan S. Cadigan, Jacob F. Baranoski, Tyler S. Cole, James J. Zhou, Candice L. Nguyen, Alexander C. Whiting, Andrew F. Ducruet, Felipe C. Albuquerque, and Michael T. Lawton

study that investigated outcomes in patients with aSAH who underwent either endovascular coiling or surgical clipping. 10 The present study attempts to assess the long-term predictive capability of the SAFIRE grading scale using the Barrow Ruptured Aneurysm Trial (BRAT) patient population by comparing patient outcomes at the 1- and 6-year follow-ups with retrospectively calculated SAFIRE grades. The BRAT contains longitudinal patient outcome data, making it an excellent population in which to analyze the viability of the SAFIRE scale in predicting long-term outcomes

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Ali M. Elhadi, Joseph M. Zabramski, Kaith K. Almefty, George A. C. Mendes, Peter Nakaji, Cameron G. McDougall, Felipe C. Albuquerque, Mark C. Preul, and Robert F. Spetzler

condition. While the clinical outcome of these patients has been well documented, the results of long-term angiographic follow-up are unknown. We undertook this study to examine long-term clinical and angiographic follow-up in patients with SAH of unknown etiology who had been identified as part of the Barrow Ruptured Aneurysm Trial (BRAT). 17 , 24 Methods Between March 2003 and January 2007, a total of 500 patients consented to participate and were enrolled in the Barrow Ruptured Aneurysm Trial (BRAT). Consent was erroneously obtained in 28 patients, leaving 472

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Robert F. Spetzler, Joseph M. Zabramski, Cameron G. McDougall, Felipe C. Albuquerque, Nancy K. Hills, Robert C. Wallace, and Peter Nakaji

T he 6-year results of the Barrow Ruptured Aneurysm Trial (BRAT) have been presented previously. 11 This trial used a prospective intent-to-treat design that randomized all patients who were admitted with a diagnosis of subarachnoid hemorrhage (SAH) to either a coiling or a clipping cohort. The design of the BRAT thus included patients with various types of aneurysms as well as patients who presented with a nonaneurysmal SAH. This all-inclusive patient database provides a unique opportunity to assess the frequency and treatment results of the various causes of

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Robert F. Spetzler, Cameron G. McDougall, Joseph M. Zabramski, Felipe C. Albuquerque, Nancy K. Hills, Jonathan J. Russin, Shahram Partovi, Peter Nakaji, and Robert C. Wallace

in good clinical condition. Therefore, evidence that the 1-year ISAT results apply to all patients with aneurysms or that the ISAT results could be replicated has been lacking. To address the issue of the broader applicability of the ISAT results, the Barrow Ruptured Aneurysm Trial (BRAT) used a prospective intent-to-treat design that randomized all patients admitted with a diagnosis of subarachnoid hemorrhage (SAH). The 1- and 3-year results have been published previously, 5 , 10 and we present here the 6-year results of BRAT. The BRAT remains an ongoing trial

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Howard A. Riina and Fred G. Barker II

T he authors present the 10-year results of the Barrow Ruptured Aneurysm Trial (BRAT) for saccular aneurysms. 5 Previous publications from the BRAT study, which compared the safety and efficacy of clipping versus coiling in patients presenting with subarachnoid hemorrhage, have included patient outcomes 1, 3, and 6 years after treatment. 4 , 6 , 7 The present publication is limited to the saccular aneurysms from the trial. The experience of the authors in the management of cerebral aneurysms is well known, and they should be commended for designing and

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R. Loch Macdonald

of Neurosurgery , where the results of the 6-year follow-up in the Barrow Ruptured Aneurysm Trial (BRAT) are published. 14 Has enough time passed to conclude that coiling is efficacious in some patients? Is another randomized trial needed? The conclusions of this paper contain a number of post hoc speculations that are certain to incite a flurry of letters and editorials, including this one. The authors should be heartened that this reflects the importance of this data set. Basically, at the 6-year follow-up when the entire data are considered, no difference is

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Robert F. Spetzler, Cameron G. McDougall, Felipe C. Albuquerque, Joseph M. Zabramski, Nancy K. Hills, Shahram Partovi, Peter Nakaji, and Robert C. Wallace

population accurately reflected the general population of patients with ruptured aneurysms. 17 , 25 To minimize the problem of selection bias, the prospective, randomized, controlled BRAT was designed as an intent-to-treat study to include all eligible patients presenting with SAH. Regardless of treatment, primary outcome was based on the assigned treatment so that one treatment modality could not benefit comparatively from the crossover of poor-grade patients to the other group. The BRAT was also an attempt to determine whether patients with acute SAH could be randomized

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Michael A. Mooney, Elias D. Simon, Scott Brigeman, Peter Nakaji, Joseph M. Zabramski, Michael T. Lawton, and Robert F. Spetzler

clinical outcome data for patients with ruptured MCA aneurysms are essential for comparison studies moving forward. For these reasons, we sought to determine the long-term outcomes associated with microsurgical treatment of ruptured MCA aneurysms in the Barrow Ruptured Aneurysm Trial (BRAT). The BRAT was a prospective, randomized study of microsurgical versus endovascular treatment of ruptured cerebral aneurysms, results of which have been published through 6 years of follow-up. 22 In this trial, patients with MCA aneurysms who were randomized to endovascular treatment

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Robert F. Spetzler, Cameron G. McDougall, Joseph M. Zabramski, Felipe C. Albuquerque, Nancy K. Hills, Peter Nakaji, John P. Karis, and Robert C. Wallace

T he 1-, 3-, and 6-year results of the Barrow Ruptured Aneurysm Trial (BRAT) have been previously reported. 7 , 16 , 17 The 6-year results for saccular aneurysms have also been previously reported. 18 In this work we are presenting the 10-year final follow-up of saccular aneurysms. Because the BRAT used a prospective intent-to-treat design that randomized all patients with nontraumatic subarachnoid hemorrhage (SAH) to either coiling or clipping on the basis of initial CT findings, enrollment included patients with angiographically negative SAH, as well as