Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes

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.

An international bibliometric study of scientific articles on intracranial aneurysms

“…Keyword analysis results showed that the words vascular disorders, flow diverter, delayed cerebral ischemia, pipeline embolization device, stent-assisted coiling, morphology, computational fluid dynamics, microsurgical clipping, and endovascular coiling were among the trend keywords, indicating the research popularity of the endovascular treatments in recent 2020) reported that endovascular treatments are more popular than clipping surgeries in the treatment of intracranial aneurysms. 27 Only one study was found to have had a bibliometric analysis of the studies on intracranial aneurysms. The study analyzed the studies published between 1991 and 2002 regarding China's growing contribution to global intracranial aneurysms research.…”

Comparison of computerized tomography angiography and digital subtraction angiography in aneurysmal subarachnoid hemorrhage

“…There are two approaches for treating these patients. The first one is clipping the aneurysm by microdissection using microscope under open surgery, and the other one is endovascular coiling which has improved within the last 10 years [25]. For classification of these patients, brain CT and Fisher scale, Hunt and Hess scale, modified Rankin score and World Federation of Neurological Surgeons (WFNS) scales are used [26].…”

Current Treatment of Anterior Communicating Artery Aneurysms: Single Center Study

“…Irregular domes have unstable walls and are prone to rupture [12]. In the literature, surgery has been shown to offer higher stability along with a lower need for retreatment in comparison to endovascular methods [13]. Aneurysms treated by endovascular treatment have more frequent rebleeding and require more frequent retreatments than surgery [7].…”

“…Recently, it has been documented that the mortality rate in SAH treated patients has decreased over time [13]. Despite the advancements of the modern neurosurgical era such as microscopes and other adjuncts (e.g., indocyanine-green videoangiography), further advances in the management of an ACoAA can still be made in endovascular methods and microsurgical techniques as well as in intensive care treatment [15].…”