Response to Letter by Nguyen and Raymond

Response:

We appreciate Nguyen and Raymond’s comments on our work regarding intraprocedural rupture (IPR) of intracranial aneurysms and are glad they have given us the opportunity to underline the exploratory nature of our analysis. As we detailed previously, this work is limited by the retrospective nature of the data and post hoc analysis, and certainly not meant to guide clinical decision-making. The main purpose of CARAT was to evaluate long-term rehemorrhage rates in patients with treated ruptured aneurysms.¹ Having the data in hand, however, is it not more appropriate to publish tertiary analyses rather than force future investigators to trudge a new track in the deep snow, particularly in near virgin territory like intraprocedural rupture? We hope that the exploratory analysis of predictors of IPR will be of interest to investigators who may want to consider some of these variables, such as COPD, in prospective studies of aneurysm treatment and IPR, along with the more relevant variables that can only be assessed prospectively, as the authors have demonstrated.^2,3