Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020

Janusz, Witold; Khorasanizadeh, MirHojjat; Maglinger, Benton; García, Alfonso; Wang, Shang‐Yu; Taussky, Philipp; Ogilvy, Christopher S.

doi:10.1016/j.wneu.2023.08.007

Cited by 3 publications

(3 citation statements)

References 286 publications

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“…Consequently, treatment-associated risks are higher and aneurysm occlusion rates are often lower than for other aneurysm locations treated endovascularly [ 24 , 46 ] or compared to microsurgical clipping [ 35 ]. Still, there are studies showing good angiographic results and relatively low risks of complications following endovascular treatment for specific MCA aneurysms [ 4 , 5 , 13 , 28 , 31 , 41 , 51 ]. Given the current patient volumes of surgically treated aneurysm patients, even in high-volume neurovascular centers, and the challenges it poses to the training of future neurovascular surgeons, as well as the swift development of endovascular devices, it seems likely that a similar shift for MCA aneurysms will take place.…”

Section: Discussionmentioning

confidence: 99%

Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Calvanese,

Auricchio,

Pohjola

et al. 2024

Acta Neurochir

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Objective Treatment modality for ruptured and unruptured intracranial aneurysms has shifted during the last two decades from microsurgical treatment towards endovascular treatment. We present how this transition happened in a large European neurovascular center. Methods We conducted a retrospective observational study consecutive patients treated for an unruptured or ruptured intracranial aneurysm at Helsinki University Hospital during 2012–2022. We used Poisson regression analysis to report age-adjusted treatment trends by aneurysm location and rupture status. Results A total of 2491 patients with intracranial aneurysms were treated (44% ruptured, 56% unruptured): 1421 (57%) surgically and 1070 (43%) endovascularly. A general trend towards fewer treated aneurysms was noted. The proportion of patients treated surgically decreased from 90% in 2012 to 20% in 2022. The age-adjusted decrease of surgical versus endovascular treatment was 6.9%/year for all aneurysms, 6.8% for ruptured aneurysms, and 6.8% for unruptured aneurysms. The decrease of surgical treatment was most evident in unruptured vertebrobasilar aneurysms (10.8%/year), unruptured communicating artery aneurysms (10.1%/year), ruptured communicating artery aneurysms (10.0%/year), and ruptured internal carotid aneurysms (9.0%/year). There was no change in treatment modality for middle cerebral artery aneurysms, of which 85% were still surgically treated in 2022. A trend towards an increasing size for treated ruptured aneurysms was found (p = 0.033). Conclusion A significant shift of the treatment modality from surgical to endovascular treatment occurred for all aneurysm locations except for middle cerebral artery aneurysms. Whether this shift has affected long-term safety and patient outcomes should be assessed in the future.

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Section: Discussionmentioning

confidence: 99%

Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Calvanese,

Auricchio,

Pohjola

et al. 2024

Acta Neurochir

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“…Intracranial aneurysms (IAs) can be appreciated in neuroimaging of approximately 3% of population [ 1 ]. Although global trends for treatment of unruptured IAs have shifted in terms of dome size and age of the treated patients [ 2 , 3 ], their annual rupture rate remains on average 9 per 100,000 population and is still related to high mortality and morbidity [ 4 ]. Survivors are at risk of various complications, one of which is cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI).…”

Section: Introductionmentioning

confidence: 99%

Differential DNA methylation associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review

Klepinowski,

Pala,

Pettersson

et al. 2024

Neurosurg Rev

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Recent studies suggest that differential DNA methylation could play a role in the mechanism of cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Considering the significance of this matter and a lack of effective prophylaxis against DCI, we aim to summarize the current state of knowledge regarding their associations with DNA methylation and identify the gaps for a future trial. PubMed MEDLINE, Scopus, and Web of Science were searched by two authors in three waves for relevant DNA methylation association studies in DCI after aSAH. PRISMA checklist was followed for a systematic structure. STROBE statement was used to assess the quality and risk of bias within studies. This research was funded by the National Science Centre, Poland (grant number 2021/41/N/NZ2/00844). Of 70 records, 7 peer-reviewed articles met the eligibility criteria. Five studies used a candidate gene approach, three were epigenome-wide association studies (EWAS), one utilized bioinformatics of the previous EWAS, with two studies using more than one approach. Methylation status of four cytosine-guanine dinucleotides (CpGs) related to four distinct genes (ITPR3, HAMP, INSR, CDHR5) have been found significantly or suggestively associated with DCI after aSAH. Analysis of epigenetic clocks yielded significant association of lower age acceleration with radiological CVS but not with DCI. Hub genes for hypermethylation (VHL, KIF3A, KIFAP3, RACGAP1, OPRM1) and hypomethylation (ALB, IL5) in DCI have been indicated through bioinformatics analysis. As none of the CpGs overlapped across the studies, meta-analysis was not applicable. The identified methylation sites might potentially serve as a biomarker for early diagnosis of DCI after aSAH in future. However, a lack of overlapping results prompts the need for large-scale multicenter studies. Challenges and prospects are discussed.

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“…This trend is accompanied by a noteworthy inclination to qualify smaller aneurysms for treatment in older patient cohorts. Presumably, this shift in clinical practice is influenced by the advancing safety profile of aneurysm treatment modalities [2,3].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Application of Risk Scores to Unruptured Anterior Communicating Artery Aneurysms

Wójtowicz,

Przepiorka,

Kujawski

et al. 2024

JCM

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Background: Treatment decisions for unruptured intracranial aneurysms (UIAs) pose a challenge for neurosurgeons, prompting the development of clinical scales assessing hemorrhage risk to provide management guidance. This study compares recommendations from the PHASES and UIA treatment scores (UIATS) applied to anterior communicating artery (AComA) UIAs against real-world management. Methods: While UIATS recommends management, for PHASES, an aneurysm with score of 10 or more was considered “high-risk”. Analysis involved assessing the concordance in each group alongside comparison to real-word management. Results: Among 129 patients, 46.5% were observed and 53.5% were treated. PHASES scores were significantly higher in the treatment group (p = 0.00002), and UIATS recommendations correlated with real-world decisions (p < 0.001). We observed no difference in the frequencies of UIATS recommendations between high- and low-risk groups. When comparing the UIATS and PHASES, 33% of high-risk aneurysms received a UIATS conservative management recommendation. In 39% of high-risk aneurysms, the UIATS recommendation was not definitive. Conversely, 27% of low-risk aneurysms obtained a UIATS UIA repair recommendation. Overall, concordance between PHASES and UIATS was 32%. Conclusions: Significant discordance in therapeutic suggestions underscores the predominant influence of center experience and individual assessments. Future studies should refine and validate decision-making strategies, potentially exploring alternative applications or developing tailored scales.

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Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020

Cited by 3 publications

References 286 publications

Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Differential DNA methylation associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review

Retrospective Application of Risk Scores to Unruptured Anterior Communicating Artery Aneurysms

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