Trial reportAJNR. American journal of neuroradiology2023
A Pragmatic Randomized Trial Comparing Surgical Clipping and Endovascular Treatment of Unruptured Intracranial Aneurysms.
Trial report in AJNR. American journal of neuroradiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 5 syntheses or guidelines pooled it, 62 citations in OpenAlex.
- Flow diverter treatment for saccular unruptured intracranial aneurysms: A systematic review focussing on study quality and initial outcomes.European stroke journal · 2026Pooled it
- Sex Disparities in Intracranial Aneurysm Trial Participation: A Systematic Review and Meta-Analysis.Cerebrovascular diseases (Basel, Switzerland) · 2026Pooled it
- Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Pooled it
- Setting benchmark for ischemic stroke treated endovascularly: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Reliability and applicability of angiographic outcome scales in WEB device-treated aneurysms: a systematic review.Neuroradiology · 2025Pooled it
- Risk Models for Adverse Events in Microsurgery for Intracranial Unruptured Aneurysms.Neurosurgery · 2026Article
- Association of cerebrovascular center volume with patient outcomes.Neurosurgical review · 2026Review
- Long-term Cerebrovascular Risk after Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms: Low Subarachnoid Hemorrhage Incidence and Persistent Stroke Susceptibility over 7,600 Patient-years.Neurologia medico-chirurgica · 2026Article
- Estimating Rupture Risk of Intracranial Aneurysms: What We Know, What We Do Not Know, and What We Need.Stroke · 2026Review
- Endovascular-assisted microsurgical clipping of ophthalmic segment aneurysms.Acta neurochirurgica · 2026Article
- Comparative Effectiveness of Surgical, Endovascular, and Conservative Strategies for Unruptured Intracranial Aneurysms.Stroke (Hoboken, N.J.) · 2026Article
- Improving Outcomes: Early Nursing Functional Evaluation of Patients with Intracranial Aneurysms After Surgery-Preliminary Results.Medicina (Kaunas, Lithuania) · 2025Article
- Review
- Molecular Targets for Intracranial Aneurysm Treatment.International journal of molecular sciences · 2025Review
- Advancing risk prediction in intracranial aneurysm clipping.Korean journal of anesthesiology · 2025Article
- Literature review and DELPHI consensus on follow-up and retreatment of intracranial aneurysms with intrasaccular devices.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Flow diverter treatment for saccular unruptured intracranial aneurysms: A systematic review focussing on study quality and initial outcomes.European stroke journal · 2025Article
- MRA evaluation of aneurysms treated with woven endobridge (WEB) devices or coils: an inter- and intra-observer reliability study.Neuroradiology · 2025Article
- Endovascular treatment of intracranial aneurysms with the Woven EndoBridge- safety and efficacy.Neuroradiology · 2025Article
- Angiographic results of aneurysms treated with Woven EndoBridge (WEB) devices or coils: an inter- and intra-observer reliability study.Neuroradiology · 2025Article
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Authors and funding
38 authors at 17 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeSurgical clipping and endovascular treatment are commonly used in patients with unruptured intracranial aneurysms. We compared the safety and efficacy of the 2 treatments in a randomized trial. MATERIALS AND
methodsClipping or endovascular treatments were randomly allocated to patients with one or more 3- to 25-mm unruptured intracranial aneurysms judged treatable both ways by participating physicians. The study hypothesized that clipping would decrease the incidence of treatment failure from 13% to 4%, a composite primary outcome defined as failure of aneurysm occlusion, intracranial hemorrhage during follow-up, or residual aneurysms at 1 year, as adjudicated by a core lab. Safety outcomes included new neurologic deficits following treatment, hospitalization of >5 days, and overall morbidity and mortality (mRS > 2) at 1 year. There was no blinding.
resultsTwo hundred ninety-one patients were enrolled from 2010 to 2020 in 7 centers. The 1-year primary outcome, ascertainable in 290/291 (99%) patients, was reached in 13/142 (9%; 95% CI, 5%-15%) patients allocated to surgery and in 28/148 (19%; 95% CI, 13%-26%) patients allocated to endovascular treatments (relative risk: 2.07; 95% CI, 1.12-3.83;
conclusionsSurgical clipping is more effective than endovascular treatment of unruptured intracranial aneurysms in terms of the frequency of the primary outcome of treatment failure. Results were mainly driven by angiographic results at 1 year.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.