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Published in: Neurosurgical Review 4/2018

01-10-2018 | Original Article

The application of the unruptured intracranial aneurysm treatment score: a retrospective, single-center study

Authors: Silvia Hernández-Durán, Dorothee Mielke, Veit Rohde, Vesna Malinova

Published in: Neurosurgical Review | Issue 4/2018

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Abstract

The unruptured intracranial aneurysm treatment score (UIATS) was published in April 2015 as a multidisciplinary consensus regarding treatment of unruptured intracranial aneurysms (UIA). As a tertiary center with focus on vascular neurosurgery, we aimed to investigate whether our treatment decision-making in patients with UIA has been in accordance with the recently published UIATS. A retrospective analysis of patients admitted to our center with UIA was performed. UIATS was applied to all identified UIA. Three decision groups were defined: (a) UIATS favoring treatment, (b) UIATS favoring observation, and (c) UIATS inconclusive. These results were then compared to our clinical decisions. Spearman’s rank-order correlation (ρ) was run to determine the relationship between the UIATS and our clinical decisions. Cases of discrepancies between UIATS and our clinical decisions were then examined for complications, defined as periprocedural adverse events in treated aneurysms, or aneurysm rupture in untreated aneurysms. Ninety-three patients with 147 UIA were included. A total of 118/147 (80.3%) UIA were treated. In 70/118 (59.3%), UIATS favored treatment, in 18/118 (15.3%), it was inconclusive, and in 30/118 (25.4%), it favored observation. A total of 29/147 (19.7%) UIA were not treated. In 15/29 (51.7%), UIATS favored observation, in 9/29 (31%), it favored treatment, and in 5/29 (17.2%), it was inconclusive (ρ = 0.366, p < 0.01). Discrepancies between UIATS and our clinical decisions did not correlate with complications (ρ = 0.034, p = 0.714). Our analysis shows that our more intuitive clinical decision-making has been in line with UIATS. Our treatment decisions did not correlate with an increased rate of complications.
Literature
4.
go back to reference Etminan N, Brown R, Beseoglu K, Juvela S, Raymond J, Morita A, Torner J, Derdeyn C, Raabe A, Mocco J, Korja M, Abdulazim A, Amin-Hanjani S, Salman R, Barrow D, Bederson J, Bonafe A, Dumont A, Fiorella D, Gruber A (2015) The unruptured intracranial aneurysm treatment score—a multidisciplinary consensus. Neurology 85:1–9CrossRef Etminan N, Brown R, Beseoglu K, Juvela S, Raymond J, Morita A, Torner J, Derdeyn C, Raabe A, Mocco J, Korja M, Abdulazim A, Amin-Hanjani S, Salman R, Barrow D, Bederson J, Bonafe A, Dumont A, Fiorella D, Gruber A (2015) The unruptured intracranial aneurysm treatment score—a multidisciplinary consensus. Neurology 85:1–9CrossRef
7.
go back to reference Hwang J, Hyun M, Lee H, Choi J, Kim J, Lee N, Kwon J, Lee E (2012) Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol 22(12):99CrossRef Hwang J, Hyun M, Lee H, Choi J, Kim J, Lee N, Kwon J, Lee E (2012) Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol 22(12):99CrossRef
8.
go back to reference International study of unruptured intracranial aneurysms investigators (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339(24):1725–1733CrossRef International study of unruptured intracranial aneurysms investigators (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339(24):1725–1733CrossRef
11.
go back to reference Kotowsi M, Naggara O, Darsaut T, Nolet S, Gevry G, Kouznetsov E, Raymond J (2013) Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 84(1):42–48. https://doi.org/10.1136/jnnp-2011-302068 CrossRef Kotowsi M, Naggara O, Darsaut T, Nolet S, Gevry G, Kouznetsov E, Raymond J (2013) Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 84(1):42–48. https://​doi.​org/​10.​1136/​jnnp-2011-302068 CrossRef
15.
go back to reference Mocco J, Brown R, Torner J, Capuano A, Fargen K, Raghavan M, Piepgras D, Meissner I, Lii J (2017) Aneurysm morphology and prediction of rupture: an international study of unruptured intracranial aneurysms analysis. Neurosurgery. https://doi.org/10.1093/neuros/nyx226 Mocco J, Brown R, Torner J, Capuano A, Fargen K, Raghavan M, Piepgras D, Meissner I, Lii J (2017) Aneurysm morphology and prediction of rupture: an international study of unruptured intracranial aneurysms analysis. Neurosurgery. https://​doi.​org/​10.​1093/​neuros/​nyx226
16.
go back to reference Mocco J, Komotar R, Lavine S, Meyers P, Connolly E, Solomon R (2004) The natural history of unruptured intracranial aneurysms. Neurosurg Focus 17(5):E3CrossRefPubMed Mocco J, Komotar R, Lavine S, Meyers P, Connolly E, Solomon R (2004) The natural history of unruptured intracranial aneurysms. Neurosurg Focus 17(5):E3CrossRefPubMed
23.
go back to reference Psychogios MN, Wachter D, Mohr A, Schramm P, Frölich AM, Jung K, Rohde V, Knauth M (2011) Feasibility of flat panel angiographic CT after intravenous contrast agent application in the postoperative evaluation of patients with clipped aneurysms. AJNR Am J Neuroradiol 32(10):1956–1962. https://doi.org/10.3174/ajnr.A2611 CrossRefPubMed Psychogios MN, Wachter D, Mohr A, Schramm P, Frölich AM, Jung K, Rohde V, Knauth M (2011) Feasibility of flat panel angiographic CT after intravenous contrast agent application in the postoperative evaluation of patients with clipped aneurysms. AJNR Am J Neuroradiol 32(10):1956–1962. https://​doi.​org/​10.​3174/​ajnr.​A2611 CrossRefPubMed
29.
go back to reference Ujiie H, Tachibana H, Hiramatsu O, Hazel A, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45(1):119–129PubMed Ujiie H, Tachibana H, Hiramatsu O, Hazel A, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45(1):119–129PubMed
Metadata
Title
The application of the unruptured intracranial aneurysm treatment score: a retrospective, single-center study
Authors
Silvia Hernández-Durán
Dorothee Mielke
Veit Rohde
Vesna Malinova
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 4/2018
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-018-0944-2

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