The Barrow Ruptured Aneurysm Trial (BRAT) provides 10-year longitudinal data comparing microsurgical clipping versus endovascular coiling outcomes.
Surgical Paradigm Probe
Input the aneurysm territory and neck morphology to identify the evidence-favored management modality based on BRAT trial longevity data.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluating patients with acute subarachnoid haemorrhage (SAH) and a confirmed ruptured aneurysm.
Deciding between microsurgical clipping and endovascular coiling.
Aiding multidisciplinary discussions in the neuro-vascular ICU.
Section 2
Literature
Development
The BRAT trial was a prospective, randomized controlled trial performed at the Barrow Neurological Institute. Unlike the ISAT trial, BRAT aimed for a "real-world" design where all patients were screened and enrolled regardless of their suitability for both treatments, providing clearer data on the treatment of complex intracranial aneurysms.
Section 3
Pearls/Pitfalls
Durability vs. Recovery
The 6-year and 10-year BRAT follow-up data showed that while surgical clipping has a higher initial morbidity, it results in superior long-term aneurysm obliteration and fewer re-treatments compared to coiling, particularly in the anterior circulation. MCA aneurysms, in particular, remain the "home base" for surgical clipping due to their morphology and easy surgical access.
Section 4
Evidence Appraisal
Primary Reference
The Barrow Ruptured Aneurysm Trial: 10-year results
Spetzler RF et al. • J Neurosurg. 2019;132(3):771-776
