Journal article
Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes
Journal of neurointerventional surgery, Vol.12(7), pp.682-687
07/01/2020
DOI: 10.1136/neurintsurg-2019-015418
PMID: 31959634
Abstract
BackgroundFollowing publication of the International Subarachnoid Aneurysm Trial (ISAT), treatment paradigms for cerebral aneurysms (CAs) shifted from open surgical clipping to endovascular embolization as primary therapy in a majority of cases. However, comprehensive analyses evaluating more recent CA diagnosis patterns, patient populations and outcomes as a function of treatment modality remain rare.MethodsThe National Inpatient Sample from 2004 to 2014 was reviewed. Aneurysmal subarachnoid hemorrhages (aSAHs) and unruptured intracranial aneurysms (UIAs) with a treatment of surgical clipping or endovascular therapy (EVT) were identified. Time trend series plots were created. Linear and logistic regressions were utilized to quantify treatment changes.Results114 137 aSAHs and 122 916 UIAs were reviewed. aSAH (+732/year, p=0.014) and UIA (+2550/year, p<0.0001) discharges increased annually. The annual caseload of surgical clippings for aSAH decreased (−264/year, p=0.0002) while EVT increased (+366/year, p=0.0003). For UIAs, the annual caseload for surgical clipping remained stable but increased for EVT (+615/year, p<0.0001). The rate of incidentally diagnosed UIAs increased annually (+1987/year; p<0.0001). Inpatient mortality decreased for clipping (p<0.0001) and EVT in aSAH (p<0.0001) (2004 vs 2014—clipping 13% vs 11.7%, EVT 15.8% vs 12.7%). Mortality rates for clipped UIAs decreased over time (p<0.0001) and remained stable for EVT (2004 vs 2014—clipping 1.57% vs 0.40%, EVT 0.59% vs 0.52%).ConclusionRuptured and unruptured CAs are increasingly being treated with EVT over clipping. Incidental unruptured aneurysm diagnoses are increasing dramatically. Mortality rates of ruptured aneurysms are improving regardless of treatment modality, whereas mortality in unruptured aneurysms is only improving for surgical clipping.
Details
- Title: Subtitle
- Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes
- Creators
- Evan Luther - University of MiamiDavid J McCarthy - University of MiamiMarie-Christine Brunet - University of MiamiSamir Sur - University of MiamiStephanie H Chen - University of MiamiDallas Sheinberg - University of MiamiDavid Hasan - University of IowaPascal Jabbour - Thomas Jefferson University HospitalDileep R Yavagal - University of MiamiEric C Peterson - University of MiamiRobert M Starke - University of Miami
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.12(7), pp.682-687
- DOI
- 10.1136/neurintsurg-2019-015418
- PMID
- 31959634
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Language
- English
- Date published
- 07/01/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984419031002771
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