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

  • Interventional Neuroradiology
  • Published:
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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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Acknowledgments

The authors are most grateful to all neurointerventionalists who participated in the survey.

Funding

Not funding was received for this manuscript.

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Authors and Affiliations

  1. Department of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada

    Johanna Ospel, Nima Kashani, Arnuv Mayank, Mohammed Almekhlafi, Alim P. Mitha, John H. Wong & Mayank Goyal

  2. Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland

    Johanna Ospel

  3. Department of Radiology, University of Calgary, Calgary, Canada

    Nima Kashani, Mohammed Almekhlafi, Alim P. Mitha, John H. Wong & Mayank Goyal

  4. University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland

    Johannes Kaesmacher

  5. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Uta Hanning

  6. Department of Radiology, Mayo Clinic, Rochester, NY, USA

    Waleed Brinjikji & Harry Cloft

  7. Division of Neurosurgery, University of Calgary, Calgary, Canada

    Alim P. Mitha & John H. Wong

  8. Department of Neuroradiology, CHU Montpellier, Montpellier, France

    Vincent Costalat

  9. Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, School for Mental Health and Sciences, Maastricht University Medical Center, Maastricht, the Netherlands

    Wim van Zwam

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  1. Johanna Ospel
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  8. Mohammed Almekhlafi
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  13. Mayank Goyal
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Corresponding author

Correspondence to Mayank Goyal.

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Conflict of interest

Johanna Ospel is supported by the University of Basel Research Foundation, Julia Bangerter Rhyner Foundation, and Freiwillige Akademische Gesellschaft Basel. The remaining authors have nothing to disclose. Mayank Goyal is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, Mentice. The remaining authors have nothing to disclose.

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For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Ospel, J., Kashani, N., Mayank, A. et al. Physician factors influencing endovascular treatment decisions in the management of unruptured intracranial aneurysms. Neuroradiology 63, 117–123 (2021). https://doi.org/10.1007/s00234-020-02509-6

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  • DOI: https://doi.org/10.1007/s00234-020-02509-6

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