Uncertainty and Agreement Regarding the Role of Flow Diversion in the Management of Difficult Aneurysms

Abstract

BACKGROUND AND PURPOSE:The role of flow diversion in the management of aneurysms remains unknown. We sought to evaluate the community agreement regarding indications for flow diversion.

Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review

“…The use of FDS made coiling the BBA easier and safer 11 16. Interestingly, in a set of difficult aneurysms, the greatest agreement was found for BBA where FDS was considered the only option (5 of 22 responders) 38. Its increasing popularity together with encouraging personal experiences and satisfactory patient outcomes has supported the concept of flow diversion also in BBAs.…”

Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model

“…A recent survey has shown that clinicians favor flow diversion of aneurysms with lateral wall morphologies rather than other types of lesions, including bifurcation aneurysms 2. However, some bifurcation aneurysms have been treated successfully by flow diversion 2–8…”

Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions

“…We have found that for simple questions with a binary outcome, as a rule of thumb a minimal number of ten raters reviewing 30-50 patients is necessary for the study to be informative. [6][7][8]20] There are many statistical approaches to measure reliability and agreement, depending on the type of data (categorical, ordinal, continuous), the sampling method and on the treatment of errors. [1] Reliability in treatment recommendations (categories) is most frequently analyzed using kappa-like statistics.…”