Grant: Operating Grant

The treatment of incidentally discovered brain aneurysms that have not yet bled is a vexing problem since the best treatment option remains uncertain. Surgery involves clipping the neck of the aneurysm to prevent blood entry into the aneurysm sac; it requires opening the skull to reach the aneurysm. Endovascular coiling involves introducing metallic coils into the aneurysm sac to occlude it and thus remove it from the brain circulation; the coils are introduced with the help of a catheter to reach the arteries of the brain. There is no scientific proof that one or the other types of treatment, in terms of long term occlusion results or safety profile, is better than the other. The Canadian UnRuptured Endovascular versus Surgery (CURES) trial is the pilot phase of a randomized trial that aims to compare endovascular coiling to surgical clipping. Randomization ensures that all patients have an equal chance of getting what will turn out to be the best option. It also helps the resolution of the dilemma, by reducing bias in the selection of patients allotted to one or the other treatment. The CURES pilot trial will recruit 260 patients across Canada, to be followed for one year. The pilot phase of CURES will allow us to: 1) determine whether there is a significant difference in the number of treatment failures between the groups of patients treated with coiling compared to clipping. Treatment failure is defined as: brain hemorrhage following treatment, failure to totally occlude the aneurysm during treatment, or recurrence of the aneurysm within the first year; 2) provide an estimate of morbidity and mortality values that will provide randomized data to guide the design of the pivotal portion of the study, which will study clinical outcomes. 3) determine feasibility of a larger (estimated 1000 patient) international trial.