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Buchta M, Griessenauer CJ. Commentary: Impact of Race on Outcomes in the Endovascular and Microsurgical Treatment in Patients With Intracranial Aneurysms. Neurosurgery 2024:00006123-990000000-01139. [PMID: 38651893 DOI: 10.1227/neu.0000000000002970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Melanie Buchta
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
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Chen C, Qiao H, Cui Z, Wang C, Zhang C, Feng Y. Clipping and coiling of intracranial aneurysms in the elderly patients: clinical features and treatment outcomes. Front Neurol 2023; 14:1282683. [PMID: 38020622 PMCID: PMC10667704 DOI: 10.3389/fneur.2023.1282683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective In recent years, more and more cases of intracranial aneurysms (IAs) have been found in elderly patients, and neurosurgical interventions have increased, but there is still no consensus on the best treatment strategy for elderly patients. In elderly patients, endovascular coiling (EC) is more popular than surgical clipping (SC) due to its advantages of less trauma and faster recovery. However, SC has made great progress in recent years, significantly improving the prognosis of elderly patients. Therefore, it is necessary to further explore the effects of different treatment modalities on clinical prognosis, hospital stay, and hospital cost of elderly IA patients, and select the most appropriate treatment modalities. Methods The authors retrospectively analyzed 767 patients with intracranial aneurysms admitted to the facility between August 2017 and December 2022. Prognostic risk factors and multivariate logistic regression were analyzed for elderly patients treated with EC or SC. The area under the receiver operating characteristic (ROC) curve was used to calculate the predictive power of each independent predictor between the treatment groups. Results Our study included 767 patients with aneurysms, of whom 348 (45.4%) were elderly, 176 (22.9%) underwent endovascular coiling, and 172 (22.4%) underwent microsurgical clipping. A comparison of elderly patients treated with EC and SC showed a higher prevalence of hypertension in the EC group (P = 0.011) and a higher Hunt-Hess score on admission in the SC group (P = 0.010). Patients in the EC group had shorter hospital stays but higher costs (P = 0.000 and P = 0.000, respectively). Patients treated with SC had a higher incidence of postoperative cerebral infarction and poor prognosis (P = 0.002 and P = 0.008, respectively). Through multi-factor logistic analysis, it was found that age (OR 1.209, 95% CI 1.047-1.397, P = 0.010), length of stay (LOS) (OR 1.160, 95 CI% 1.041-1.289, P = 0.007), and complications (OR 31.873, 95 CI% 11.677-320.701, P = 0.000) was an independent risk factor for poor prognosis in elderly patients with EC. In elderly patients treated with SC, age (OR 1.105, 95% CI 1.010-1.209, P = 0.029) was an independent risk factor for poor prognosis. Conclusion EC and SC interventions in elderly adults carry higher risks compared to non-older adults, and people should consider these risks and costs when making a decision between intervention and conservative treatment. In elderly patients who received EC or SC treatments, EC showed an advantage in improving outcomes in elderly patients although it increased the economic cost of the patient's hospitalization.
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Affiliation(s)
| | | | | | | | | | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Gaub M, Kromenacker B, Avila MJ, Gonzales-Portillo GS, Aguilar-Salinas P, Dumont TM. Evolution of open surgery for unruptured intracranial aneurysms over a fifteen year period-increased difficulty and morbidity. J Clin Neurosci 2023; 107:178-183. [PMID: 36443125 DOI: 10.1016/j.jocn.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The approach to intervention for unruptured intracranial aneurysms (UIAs) remains controversial. Utilization of endovascular techniques for aneurysm repair increased dramatically during the last decade. We sought to analyze recent national trends for electively treated (open and endovascular) UIAs focusing on pre-existing patient disease burden and intervention modality selection. METHODS The Nationwide Inpatient Sample (NIS) national database was used to identify patients with primary diagnosis codes of unruptured intracranial aneurysm between 1999 and 2014. Patients were dichotomized by intervention into endovascular or open surgical treatment. Analysis of pre-existing disease severity were calculated using the Elixhauser comorbidity index. Complications of combined peri-procedural stroke or death during admission and hospital length of stay were used as primary endpoints for comparison. RESULTS The percent of total UIAs treated electively with open approach decreased from more than 95 % of cases in 1999 to less than 25 % in 2014. Patients undergoing clipping were 3 years younger than those in the endovascular group (p < 0.001). The rate of primary endpoint complications (stroke and death) and length of stay for open cases saw a decrease throughout the study but remained statistically higher when compared to the endovascular group over the study period (p < 0.001). Additionally, non-neurologic complications increased over the time period for open cases. The average preoperative co-morbid disease severity for all groups treated increased over this interval. Conversely, the relative volume of endovascular cases increased but the rate of complications and average group disease remained statistically lower than the surgical clipping group (p < 0.05). CONCLUSION The percent of UIAs treated electively with open approach has decreased since 1999 with a concomitant increase in complication rate in particular compared to endovascular cases. However, the health characteristics of patients treated with surgical clipping show an increase in severity of pre-existing co-morbidities. Further research into factors contributing to this finding, including potential socioeconomic differences and changes in surgeon experience are needed.
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Affiliation(s)
- Michael Gaub
- The University of Arizona, College of Medicine, Tucson, AZ, United States; UT Health San Antonio, United States
| | - Bryan Kromenacker
- The University of Arizona, College of Medicine, Tucson, AZ, United States
| | - Mauricio J Avila
- The University of Arizona, College of Medicine, Tucson, AZ, United States; Department of Neurosurgery, University of Arizona, Tucson, AZ, United States
| | | | - Pedro Aguilar-Salinas
- The University of Arizona, College of Medicine, Tucson, AZ, United States; Department of Neurosurgery, University of Arizona, Tucson, AZ, United States
| | - Travis M Dumont
- The University of Arizona, College of Medicine, Tucson, AZ, United States; Department of Neurosurgery, University of Arizona, Tucson, AZ, United States.
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Raygor KP, Phelps RRL, Rutledge C, Raper DMS, Molinaro A, Fox CK, Gupta N, Abla AA. Socioeconomic factors associated with pediatric moyamoya disease hospitalizations: a nationwide cross-sectional study. J Neurosurg Pediatr 2022:1-10. [PMID: 35334457 DOI: 10.3171/2022.1.peds21339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Healthcare disparities are widely described in adults, but barriers affecting access to care for pediatric patients with moyamoya disease (MMD) are unknown. Understanding socioeconomic factors impacting hospital access and outcomes is necessary to address pediatric healthcare disparities. METHODS In this cross-sectional observational study, the Kids' Inpatient Database was used to identify patients admitted with a primary diagnosis of MMD from 2003 to 2016. Patients ≤ 18 years with a primary diagnosis of MMD based on International Classification of Diseases (ICD) codes were included. Hospital admissions were queried for use of cerebral revascularization based on ICD procedure codes. RESULTS Query of the KID yielded 1449 MMD hospitalizations. After multivariable regression, Hispanic ethnicity (OR 0.52 [95% CI 0.33-0.81], p = 0.004) was associated with lack of surgical revascularization. Private insurance (OR 1.56 [95% CI 1.15-2.13], p = 0.004), admissions at medium- and high-volume centers (OR 2.01 [95% CI 1.42-2.83], p < 0.001 and OR 2.84 [95% CI 1.95-4.14], p < 0.001, respectively), and elective hospitalization (OR 3.37 [95% CI 2.46-4.64], p < 0.001) were positively associated with revascularization. Compared with Caucasian race, Hispanic ethnicity was associated with increased mean (± SEM) length of stay by 2.01 ± 0.70 days (p = 0.004) and increased hospital charges by $24,333.61 ± $7918.20 (p = 0.002), despite the decreased utilization of surgical revascularization. Private insurance was associated with elective admission (OR 1.50 [95% CI 1.10-2.05], p = 0.01) and admission to high-volume centers (OR 1.90 [95% CI 1.26-2.88], p = 0.002). African American race was associated with the development of in-hospital complications (OR 2.52 [95% CI 1.38-4.59], p = 0.003). CONCLUSIONS Among pediatric MMD hospitalizations, multiple socioeconomic factors were associated with access to care, whether surgical treatment is provided, and whether in-hospital complications occur. These results suggest that socioeconomic factors are important drivers of healthcare disparities in children with MMD and warrant further study.
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Affiliation(s)
- Kunal P Raygor
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Ryan R L Phelps
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Caleb Rutledge
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Daniel M S Raper
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Annette Molinaro
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Christine K Fox
- 2Department of Neurology, University of California, San Francisco, California
| | - Nalin Gupta
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Adib A Abla
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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Kailaya-Vasan A, Frantzias J, Kailaya-Vasan J, Anderson IA, Walsh DC. Current decision support tools fail to agree or predict therapeutic decisions in a single cohort of unruptured intracranial aneurysms. Acta Neurochir (Wien) 2022; 164:771-779. [PMID: 33956233 PMCID: PMC8913469 DOI: 10.1007/s00701-021-04852-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/13/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND There is limited evidence to direct the management of unruptured intracranial aneurysms. Models extrapolated from existing data have been proposed to guide treatment recommendations. The aim of this study is to assess whether a consensus-based treatment score (UIATS) or rupture rate estimation model (PHASES) can be used to benchmark UK multi-disciplinary team (MDT) practice. METHODS Prospective data was collected on a consecutive series of all patients with unruptured intracranial aneurysms (UIAs) presenting to a major UK neurovascular centre between 2012 and 2015. The agreement between the UIATS and PHASES scores, and their sensitivity and specificity in predicting the real-world MDT outcome were calculated and compared. RESULTS A total of 366 patients (456 aneurysms) were included in the analysis. The agreement between UIATS and MDT recommendation was low (weighted kappa 0.26 [95% CI 0.19, 0.32]); sensitivity and specificity were also low at 36% and 52% respectively. Groups that the MDT allocated to treatment, equipoise or no treatment had significantly different PHASES scores (p = 0.004). There was no significant difference between the two scores when predicting patients for whom MDT outcome was to recommend aneurysm treatment, but the UIATS score was superior in predicting patients who received an MDT recommendation of 'treatment-equipoise', or 'not-for-treatment' (AUC of 0.73 compared to 0.59 for PHASES). CONCLUSIONS The models studied failed to agree with the consensus view of multi-disciplinary team in a major neurovascular centre. We conclude that decision support tools such as the UIATS and PHASES scores should not be blindly introduced in respective institutions without prior internal validation, as they may not represent the local reality.
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Affiliation(s)
- Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK.
| | - Joseph Frantzias
- Department of Neurosurgery, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Jayantan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Ian A Anderson
- Department of Neurosurgery, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
- Institute of Psychiatry, King's College London, DeCrespigny Park, London, UK
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Skodvin TØ, Kloster R, Sorteberg W, Isaksen JG. Survey of European neurosurgeons' management of unruptured intracranial aneurysms: inconsistent practice and organization. Acta Neurochir (Wien) 2021; 163:113-121. [PMID: 32870423 PMCID: PMC7778617 DOI: 10.1007/s00701-020-04539-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022]
Abstract
Background The discovery of an unruptured intracranial aneurysm creates a dilemma between observation and treatment. Neurosurgeons’ routines for risk assessment and treatment decision-making are unknown. The position of evidence-based medicine in European neurosurgery is considered to be weak, high-grade guidelines do not exist and variations between institutions are probable. We aimed to explore European neurosurgeons’ management routines for newly discovered unruptured intracranial aneurysms. Methods In cooperation with the European Association of Neurosurgical Societies (EANS), we conducted an online, cross-sectional survey of 420 European neurosurgeons during Spring/Summer 2016 (1533 non-Norwegians invited through the EANS, and 16 Norwegians invited through heads of departments because of the need for additional information for a separate study). We asked about demographic variables, routines for management and risk assessment of newly discovered unruptured intracranial aneurysms and presented a case. We collected information about gross domestic product (GDP) per capita from the International Monetary Fund. Results The response rate to the invite from the EANS was 26%, with respondents from 47 countries. More than half of the respondents (n = 226 [54%]) reported that their department treated less than 25 unruptured aneurysms yearly. Forty percent said their department used aneurysm size cut-off to guide treatment decisions, with a mean size of 6 mm. Presented with a case, respondents from countries with a lower GDP per capita recommended intervention more often than respondents from higher-income countries. Vascular neurosurgeons more commonly recommended observation. Conclusion The answers to this self-reported survey indicate that many centers have a treatment volume lower than recommended by international guidelines, and that there are socioeconomic differences in care. Better documentation of treatment and outcome, for example with clinical quality registries, is needed to drive improvements of care. Electronic supplementary material The online version of this article (10.1007/s00701-020-04539-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Torbjørn Øygard Skodvin
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway.
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway.
- Hospital of Southern Norway, Kristiansand, Norway.
| | - Roar Kloster
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Wilhelm Sorteberg
- Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jørgen Gjernes Isaksen
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
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Neyazi B, Swiatek VM, Skalej M, Beuing O, Stein KP, Hattingen J, Preim B, Berg P, Saalfeld S, Sandalcioglu IE. Rupture risk assessment for multiple intracranial aneurysms: why there is no need for dozens of clinical, morphological and hemodynamic parameters. Ther Adv Neurol Disord 2020; 13:1756286420966159. [PMID: 33403004 PMCID: PMC7739206 DOI: 10.1177/1756286420966159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction: A multitude of approaches have been postulated for assessing the risk of intracranial aneurysm rupture. However, the amount of potential predictive factors is not applicable in clinical practice and they are rejected in favor of the more practical PHASES score. For the subgroup of multiple intracranial aneurysms (MIAs), the PHASES score might severely underestimate the rupture risk, as only the aneurysm with the largest diameter is considered for risk evaluation. Methods: In this study, we investigated 38 patients harboring a total number of 87 MIAs with respect to their morphological and hemodynamical characteristics. For the determination of the best suited parameters regarding their predictive power for aneurysm rupture, we conducted three phases of statistical evaluation. The statistical analysis aimed to identify parameters that differ significantly between ruptured and unruptured aneurysms, show smallest possible correlations among each other and have a high impact on rupture risk prediction. Results: Significant differences between ruptured and unruptured aneurysms were found in 16 out of 49 parameters. The lowest correlation were found for gamma, aspect ratio (AR1), aneurysm maximal relative residence time (Aneurysm_RRT_max) and aneurysm mean relative residence time. The data-driven parameter selection yielded a significant correlation of only two parameters (AR1 and the Aneurysm_RRT_max) with rupture state (area under curve = 0.75). Conclusion: A high number of established morphological and hemodynamical parameters seem to have no or only low effect on prediction of aneurysm rupture in patients with MIAs. For best possible rupture risk assessment of patients with MIAs, only the morphological parameter AR1 and the hemodynamical parameter Aneurysm_RRT_max need to be included in the prediction model.
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Affiliation(s)
- Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Leipziger Straße 44, Magdeburg, Saxony Anhalt 39120, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Martin Skalej
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Jörg Hattingen
- Institute of Neuroradiology, KRH Klinikum Nordstadt, Hanover, Niedersachsen, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
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Feghali J, Gami A, Caplan JM, Tamargo RJ, McDougall CG, Huang J. Management of unruptured intracranial aneurysms: correlation of UIATS, ELAPSS, and PHASES with referral center practice. Neurosurg Rev 2020; 44:1625-1633. [PMID: 32700160 DOI: 10.1007/s10143-020-01356-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Concordance between the Unruptured Intracranial Aneurysm Treatment Score (UIATS), Earlier Subarachnoid Hemorrhage, Location, Age, Population, Size, Shape (ELAPSS) score, and Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score with real-world management decisions in unruptured intracranial aneurysms (UIAs) remains unclear, especially in current practice. This study aimed to investigate this concordance, while developing an optimal model predictive of recent decision practices at a quaternary referral center. A prospective database of patients presenting with UIAs to our institution from January 1 to December 31, 2018, was used. Concordance between the scores and real-world management decisions on every UIA was assessed. Complications and length of stay (LOS) were compared between aneurysms in the UIATS-recommended treatment and observation groups. A subgroup analysis of concordance was also conducted among junior and senior surgeons. An optimal logistic regression model predictive of real-world decisions was also derived. The cohort consisted of 198 patients with 271 UIAs, of which 42% were treated. The UIATS demonstrated good concordance with an AUC of 0.765. Of the aneurysms in the UIATS-recommended "observation" group, 22% were discordantly treated. The ELAPSS score demonstrated good discrimination (AUC = 0.793), unlike the PHASES score (AUC = 0.579). Endovascular treatment rates, complications, and LOS were similar between aneurysms in the UIATS-recommended treatment and observation groups. Similar concordance was obtained among junior and senior surgeons. The optimal predictive model consisted of several significantly associated variables and had an AUC of 0.942. Cerebrovascular specialists may be treating aneurysms slightly more than these scores would recommend, independently of years in practice. Wide variation still exists in management practices of UIAs.
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Affiliation(s)
- James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhishek Gami
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cameron G McDougall
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Hospital, 1800 Orleans Street, Sheikh Zayed Tower 6115F, Baltimore, MD, 21287, USA.
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9
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Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms. Stroke 2018; 49:848-855. [DOI: 10.1161/strokeaha.117.020342] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/10/2018] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
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Ravindra VM, de Havenon A, Gooldy TC, Scoville J, Guan J, Couldwell WT, Taussky P, MacDonald JD, Schmidt RH, Park MS. Validation of the unruptured intracranial aneurysm treatment score: comparison with real-world cerebrovascular practice. J Neurosurg 2017; 129:100-106. [PMID: 28984518 DOI: 10.3171/2017.4.jns17548] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs). METHODS All patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS. Patients were categorized in a contingency table assessing UIATS recommendation versus real-world treatment decision. The authors calculated the percentage of misclassification, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. RESULTS A total of 221 consecutive patients with UIAs met the inclusion criteria: 69 (31%) patients underwent treatment and 152 (69%) did not. Fifty-nine (27%) patients had a UIATS between -2 and 2, which does not offer a treatment recommendation, leaving 162 (73%) patients with a UIATS treatment recommendation. The UIATS was significantly associated with treatment (p < 0.001); however, the sensitivity, specificity, and percentage of misclassification were 49%, 80%, and 28%, respectively. Notably, 51% of patients for whom treatment would be recommended by the UIATS did not undergo treatment in the real-world cohort and 20% of patients for whom conservative management would be recommended by UIATS had intervention. The area under the ROC curve was 0.646. CONCLUSIONS Compared with the authors' experience, the UIATS recommended overtreatment of UIAs. Although the UIATS could be used as a screening tool, individualized treatment recommendations based on consultation with a cerebrovascular specialist are necessary. Further validation with longitudinal data on rupture rates of UIAs is needed before widespread use.
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Affiliation(s)
| | - Adam de Havenon
- 2Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Timothy C Gooldy
- 3Department of Neurosurgery, University of Florida School of Medicine, Gainesville, Florida
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