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Published in: Neuroradiology 1/2021

01-01-2021 | Intracranial Aneurysm | Interventional Neuroradiology

Physician factors influencing endovascular treatment decisions in the management of unruptured intracranial aneurysms

Authors: Johanna Ospel, Nima Kashani, Arnuv Mayank, Johannes Kaesmacher, Uta Hanning, Waleed Brinjikji, Harry Cloft, Mohammed Almekhlafi, Alim P. Mitha, John H. Wong, Vincent Costalat, Wim van Zwam, Mayank Goyal

Published in: Neuroradiology | Issue 1/2021

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Abstract

Purpose

Deciding about whether an unruptured intracranial aneurysm (UIA) should be treated or not is challenging because robust data on rupture risks, endovascular treatment complication rates, and treatment success rates are limited. We aimed to investigate how neurointerventionalists conceptually approach endovascular treatment decision-making in UIAs.

Methods

In a web-based international multidisciplinary case-based survey among neurointerventionalists, participants provided their demographics and UIA treatment-volumes, estimated 5-year rupture rates, endovascular treatment complication and success rates and gave their endovascular treatment decision for 15 pre-specified UIA case-scenarios. Differences in estimated 5-year rupture rates, endovascular treatment complication and success rates based on physician and hospital characteristics were evaluated with the Kruskal-Wallis test. Multivariable logistic regression analysis was used to derive adjusted effect size estimates for predictors of endovascular treatment decision.

Results

Two hundred-thirty-three neurointerventionalists from 38 countries participated in the survey (median age 47 years [IQR: 41–55], 25/233 [10.7%] females). The ranges of estimates for 5-year rupture risks, endovascular treatment complication rates, and particularly endovascular treatment success rates were wide, especially for UIAs in the posterior circulation. Estimated 5-year rupture risks, endovascular treatment complication and success rates differed significantly based on personal and institutional endovascular UIA treatment volume, and all three estimates were significantly associated with physicians’ endovascular treatment decision.

Conclusion

Although several predictors of endovascular treatment decision were identified, there seems to be a high degree of uncertainty when estimating rupture risks, treatment complications, and treatment success for endovascular UIA treatment. More data on the clinical course of UIAs with and without endovascular treatment is needed.
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Metadata
Title
Physician factors influencing endovascular treatment decisions in the management of unruptured intracranial aneurysms
Authors
Johanna Ospel
Nima Kashani
Arnuv Mayank
Johannes Kaesmacher
Uta Hanning
Waleed Brinjikji
Harry Cloft
Mohammed Almekhlafi
Alim P. Mitha
John H. Wong
Vincent Costalat
Wim van Zwam
Mayank Goyal
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 1/2021
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-020-02509-6

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