Long-term Economic Impact of Coiling vs Clipping for Unruptured Intracranial Aneurysms

Lad, Shivanand P.; Babu, Ranjith; Rhee, Michael S.; Franklin, Robbi L.; Ugiliweneza, Beatrice; Hodes, Jonathan E.; Nimjee, Shahid M; Zomorodi, Ali R.; Smith, Tony P.; Friedman, Allan H.; Patil, Chirag G.; Boakye, Maxwell

doi:10.1227/01.neu.0000429284.91142.56

Cited by 57 publications

(36 citation statements)

References 36 publications

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“…First, administrative claims data including MarketScan and Medicare are routinely used for population-based comparative effectiveness research. 13 This data source reduces the common biases that result from selecting patients from particular surgeons, institutions, or regions, and reflects a nationally representative range of skill level and institutional size and volume. Although the data are not weighted to the national population, this reflects ETV outcomes in the real-world setting of up to one-sixth of the US population.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric endoscopic third ventriculostomy: a population-based study

Lam

Harris

Rocque

et al. 2014

PED

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Object Endoscopic third ventriculostomy (ETV) is an alternative to ventriculoperitoneal shunting for hydrocephalus treatment. Choice of treatment options raises questions about which patients are likely to benefit from ETV. The authors performed a population-based analysis using an administrative claims database, examining current practice and outcomes for pediatric patients in the US. Methods The authors queried the MarketScan (Truven Health Analytics) database for Current Procedural Terminology codes corresponding to ETV and ventriculoperitoneal shunting from 2003 to 2011; they included patients 19 years or younger and extracted data from initial and subsequent hospitalizations. Hydrocephalus etiology was classified with ICD-9-CM coding. ETV failure was defined as any subsequent ETV or shunt procedure. Results Five hundred one patients underwent ETV. Of these, 46% were female. The mean age was 8.7 ± 6.4 years (± SD). The mean follow-up was 1.9 ± 1.8 years. Etiology of hydrocephalus was primarily tumor (41.7%) and congenital/aqueductal stenosis (24.4%). ETV was successful in 354 patients (71%). The mean time to failure was 109.9 ± 233 days. Of the 147 patients with ETV failure, 35 (24%) underwent repeat ETV and 112 (76%) had shunt placement. Patients in age groups 0 to < 6 months and 6 months to < 1 year had a significantly higher rate of ETV failure than those 10–19 years (HR 2.9, p = 0.05; and HR 2.3, p = 0.001, respectively). History of prior shunt was associated with higher risk of failure (HR 2.5, p < 0.001). There were no significant associations between hydrocephalus etiology and risk of failure. A second wave of failures occurred at 2.5–3.5 years postoperative in tumor and congenital/aqueductal stenosis patients; this was not observed in other etiology groups. Conclusions This study represents a cross-section of nationwide ETV practice over 9 years. ETV success was more likely among children 1 year and older and those with no history of prior shunt.

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Section: Discussionmentioning

confidence: 99%

“…While administrative claims data have been used to explore topics in adult neurosurgery, 13 it has not been used to investigate ETV in children. This study aims to use a large administrative database to describe the current practice, correlates, and effectiveness of ETV in pediatric patients in the US.…”

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confidence: 99%

Pediatric endoscopic third ventriculostomy: a population-based study

Lam

Harris

Rocque

et al. 2014

PED

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“…9,10 The frequencies of aneurysm rests or recurrences are higher after coil embolization than that after surgical clipping. 11,12 Recent studies have revealed that recanalization after coil embolization occurs not only in the short term (typically within 1 year) but also in the long term (after several years). 1,[13][14][15][16] Repeated angiographic examinations or treatments because of the recanalization of coiled aneurysms result in a significant reduction in patient quality of life.…”

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confidence: 99%

Blood Flow Into Basilar Tip Aneurysms

Sugiyama

Niizuma

Sato

et al. 2016

Stroke

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We retrospectively investigated the clinical and radiological data from 111 consecutive patients who underwent endovascular treatment Background and Purpose-Hemodynamic forces may play a role in the recanalization of coiled aneurysms. The purpose of this study was to investigate the influence of presurgical hemodynamics on the efficacy of coil embolization for basilar tip aneurysms. Methods-We identified 82 patients who underwent endovascular coil embolization for basilar tip aneurysms with a followup of >1 year. Presurgical hemodynamics were investigated using computational fluid dynamics with 3-dimensional data derived from rotational angiography. During postprocessing, we quantified the rate of net flow entering the aneurysm through its neck and calculated the proportion of the aneurysmal inflow rate to the basilar artery flow rate. In addition, we investigated the correlation between the basilar bifurcation configuration and the hemodynamics. Results-Twenty-five of the 82 patients were excluded because of difficult vascular geometry reconstruction. Among the 57 examined patients, angiographic recanalization was observed in 19 patients (33.3%). The proportion of the aneurysmal inflow rate to the basilar artery flow rate and a coil packing density <30% were independent and significant predictors for the recanalization of coiled aneurysms. Additional investigation revealed that a small branch angle formed by the basilar artery and the posterior cerebral artery increased blood flow into the aneurysm. Conclusions-The proportion of the aneurysmal inflow rate to the basilar artery flow rate, influenced by the basilar bifurcation configuration, was an independent and significant predictor for recanalization after coil embolization in basilar tip aneurysms.

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“…They observed that although hospital length of stay and costs were higher in the clipping group for the initial procedure, whereas the overall costs at 2 and 5 years were similar in the clipping and coiling cohorts. [56] However, there is no true blinded randomized study that compares surgical clipping and Endovascular therapy.…”

Section: Surgical Clipping Versus Endovascular Therapy (Evt)mentioning

confidence: 99%

Treatment of unruptured intracranial aneurysms: a review

Ambekar

Khandelwal

Bhattacharya

et al. 2016

Expert Review of Neurotherapeutics

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In this article, we discuss the important natural history studies of UIAs and discuss the existing scientific evidence and recent advances that help identify the rupture risk guide management of UIAs. We also address the recent advances in pharmacological therapy of UIAs. Expert commentary: In the recent years, there have been great advances in understanding the pathophysiology of UIAs and determining the rupture risk going beyond the traditional parameter of aneurysm size. Aneurysm morphology and hemodynamics play a pivotal role in growth and rupture. A true randomized trial for the management of UIAs is the need of the hour.

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Long-term Economic Impact of Coiling vs Clipping for Unruptured Intracranial Aneurysms

Abstract: : SAH, subarachnoid hemorrhageUIAs, unruptured intracranial aneurysms.

Cited by 57 publications

References 36 publications

Pediatric endoscopic third ventriculostomy: a population-based study

Pediatric endoscopic third ventriculostomy: a population-based study

Blood Flow Into Basilar Tip Aneurysms

Treatment of unruptured intracranial aneurysms: a review

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