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Changing the Rules of the Game: The Problem of Surrogate Angiographic Outcomes in the Evaluation of Aneurysm Treatments

Changing the Rules of the Game: The Problem of Surrogate Angiographic Outcomes in the Evaluation... EDITORIAL to that concern is that the clinical results are what count; they were Changing the Rules of the Game: The better with coiling in ISAT. In themeantime, becausecomplete Problem of Surrogate Angiographic occlusions were infrequent with coiling, we learned to accept a re- sidual neck as “acceptable” because rebleeding was rare compared Outcomes in the Evaluation of with patients with residual aneurysms. Aneurysm Treatments Now flow diverters are introduced; how can the case be made that they should be used instead of coiling? A randomized trial T.E. Darsaut, R. Chapot, and J. Raymond with a clinical outcome measure, say, to ensure the complication rate of flow diversion was not double that of coiling (ie, 5% to urrogate outcomes (indicators or signs used in place of the 10%), would require at least 865 patients. So, we use a surrogate Strue clinical outcome measure) are often used in the evalua- 1 angiographic outcome. But because we now consider residual tion of neurovascular treatments, but there are many pitfalls. necks as “satisfactory” and we can obtain this result in 80%–90% The various ways surrogate angiographic outcomes are handled of cases, even this strategy won’t work: a trial of 1000–1500 in our http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Changing the Rules of the Game: The Problem of Surrogate Angiographic Outcomes in the Evaluation of Aneurysm Treatments

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Publisher
American Journal of Neuroradiology
Copyright
© 2020 by American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A6825
Publisher site
See Article on Publisher Site

Abstract

EDITORIAL to that concern is that the clinical results are what count; they were Changing the Rules of the Game: The better with coiling in ISAT. In themeantime, becausecomplete Problem of Surrogate Angiographic occlusions were infrequent with coiling, we learned to accept a re- sidual neck as “acceptable” because rebleeding was rare compared Outcomes in the Evaluation of with patients with residual aneurysms. Aneurysm Treatments Now flow diverters are introduced; how can the case be made that they should be used instead of coiling? A randomized trial T.E. Darsaut, R. Chapot, and J. Raymond with a clinical outcome measure, say, to ensure the complication rate of flow diversion was not double that of coiling (ie, 5% to urrogate outcomes (indicators or signs used in place of the 10%), would require at least 865 patients. So, we use a surrogate Strue clinical outcome measure) are often used in the evalua- 1 angiographic outcome. But because we now consider residual tion of neurovascular treatments, but there are many pitfalls. necks as “satisfactory” and we can obtain this result in 80%–90% The various ways surrogate angiographic outcomes are handled of cases, even this strategy won’t work: a trial of 1000–1500 in our

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Dec 1, 2020

References