Shifting Treatment Paradigms for Ruptured Aneurysms from Open Surgery to Endovascular Therapy Over 25 Years

Bender, Matthew T.; Wendt, Haley; Monarch, Thomas; Lin, Li-Mei; Jiang, Bowen; Huang, Judy; Coon, Alexander L.; Tamargo, Rafael J.; Colby, Geoffrey P.

doi:10.1016/j.wneu.2017.07.074

Cited by 38 publications

(22 citation statements)

References 33 publications

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“…Interestingly, we also found a significant, although smaller, shift towards EVT use for RA, which was unexpected given that the PED was approved for treating UA. Perhaps the continued successful usage of EVT for UA influenced the practice patterns for RA 15 16. Our data support this explanation, given a delay was observed in a paradigm shift for RA, beginning more so after 2015 compared with the immediate effect for UA in 2012 (figure 1A,B).…”

Section: Discussionsupporting

confidence: 73%

Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery

Wang

Campos

Colby

et al. 2020

J NeuroIntervent Surg

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BackgroundFlow modulation is the newest endovascular technique for treatment of cerebral aneurysms.ObjectiveTo investigate changes in aneurysm treatment practice patterns in the USA.MethodsFrom the 2007 to 2016, the National Inpatient Sample databases, hospital discharges associated with unruptured aneurysms (UA), and/or ruptured aneurysms (RA) having undergone surgical clipping (SC) and/or endovascular treatments (EVT) were identified using the International Classification of Diseases codes. Patient demographics, hospital characteristics, and clinical outcomes were reviewed. Five year subgroup analyses were performed for treatment differences.ResultsA total of 39 282 hospital discharges were identified with a significant increase in EVT (UA: SC n=7847 vs EVT n=12 797, p<0.001; RA: SC n=8108 vs EVT n=10 530, p<0.001). Hospitals in the South demonstrated the most significant EVT use regardless of aneurysm status (UA: SC n=258.5±53.6 vs EVT n=480.7±155.8, p<0.001; RA: SC n=285.6±54.3 vs EVT n=393.3±102.9, p=0.003). From 2007 to 2011, there was no significant difference in the mean number of cases for the treatment modalities (UA: SC n=847.4±107.7 vs EVT n=1120.4±254.1, p=0.21; RA: SC n=949.4±52.8 vs EVT n=1054.4±219.6, p=0.85). Comparatively, from 2012 to 2016, significantly more UA and RA were treated endovascularly (UA: SC n=722.0±43.4 vs EVT n=1439.0±419.2, p<0.001; RA: SC n=672.2±61.4 vs EVT n=1051.6±330.2, p=0.02).ConclusionsAs technological innovations continue to advance the neuroendovascular space, the standard of care for treatment of cerebral aneurysms is shifting further towards endovascular therapies over open surgical approaches in the USA.

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Section: Discussionsupporting

confidence: 73%

Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery

Wang

Campos

Colby

et al. 2020

J NeuroIntervent Surg

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“…Over the last decades, endovascular therapy of intracranial aneurysms (IA) using coil embolization has been established as a standard treatment approach [1]. Owing to the wide range of materials and devices available, a well-founded education for beginning neurointerventionalists and constant practice for advanced physicians is indispensable, aiming to maintain high neurointerventional standards [2,3].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a customizable training environment for neurointerventional skills assessment

et al. 2020

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Objective To meet increasing demands to train neuroendovascular techniques, we developed a dedicated simulator applying individualized three-dimensional intracranial aneurysm models ('HANNES'; Hamburg Anatomic Neurointerventional Endovascular Simulator). We hypothesized that HANNES provides a realistic and reproducible training environment to practice coil embolization and to exemplify disparities between neurointerventionalists, thus objectively benchmarking operators at different levels of experience.

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“…Before 1990, neurosurgical operations were the only option for patients with intracranial aneurysm [ 3 ]. At 1992, Guglielmi detachable platinum coils(GDC) were introduced as an endovascular treatment which provided patients with an additional treatment option [ 4 – 6 ]. Endovascular coil emblization eventually became the preferred modality for many patients, due to better clinical outcomes than neurosurgical clipping in some patients with intracranial aneurysm demonstrated in ISAT(International Subarachnoid Aneurysm Trial) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials

et al. 2018

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BackgroundRecent studies have shown conflicting results regarding the effect of hydrogel coils for treating intracranial aneurysm compared to bare platinum coils. We implemented a meta-analysis to assess the value of hydrogel coils in intracranial aneurysm treatment.MethodsThe MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) which had evaluated hydrogel coils versus bare platinum coils for intracranial aneurysms.ResultsWe pooled 1526 patients from 4 RCTs with the mean follow-up time of more than 16 months. Hydrogel coils had reductions on mid-term recurrence (RR 0.78, 95% CI 0.65 to 0.94, P = 0.008) and residual aneurysm (RR 0.71, 95% CI 0.57 to 0.88, P = 0.002), but didn’t show any significant differences in other favorable outcomes such as functional recovery, mortality and so on. In the subgroup analysis, we found that second-generation hydrogel coils might exhibit potential impacts on increasing mid-term complete occlusion (RR 1.26, 95% CI 1.07 to 1.48, P = 0.005) and decreasing residual aneurysm neck. (RR 0.54, 95% CI 0.34 to 0.86, P = 0.010).ConclusionsHydrogel coils showed no significant efficacy on functional recovery but exhibited a lower rate of recurrences and residual aneurysms in patients with intracranial aneurysms.Electronic supplementary materialThe online version of this article (10.1186/s12883-018-1171-8) contains supplementary material, which is available to authorized users.

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Shifting Treatment Paradigms for Ruptured Aneurysms from Open Surgery to Endovascular Therapy Over 25 Years

Cited by 38 publications

References 33 publications

Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery

Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery

Feasibility of a customizable training environment for neurointerventional skills assessment

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials

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