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- Title
Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center.
- Authors
Calvanese, Francesco; Auricchio, Anna Maria; Pohjola, Anni; Hafez, Ahmad; Nurminen, Ville; Korja, Miikka; Numminen, Jussi; Lehecka, Martin; Raj, Rahul; Niemelä, Mika
- Abstract
Objective: Treatment modality for ruptured and unruptured intracranial aneurysms has shifted during the last two decades from microsurgical treatment towards endovascular treatment. We present how this transition happened in a large European neurovascular center. Methods: We conducted a retrospective observational study consecutive patients treated for an unruptured or ruptured intracranial aneurysm at Helsinki University Hospital during 2012–2022. We used Poisson regression analysis to report age-adjusted treatment trends by aneurysm location and rupture status. Results: A total of 2491 patients with intracranial aneurysms were treated (44% ruptured, 56% unruptured): 1421 (57%) surgically and 1070 (43%) endovascularly. A general trend towards fewer treated aneurysms was noted. The proportion of patients treated surgically decreased from 90% in 2012 to 20% in 2022. The age-adjusted decrease of surgical versus endovascular treatment was 6.9%/year for all aneurysms, 6.8% for ruptured aneurysms, and 6.8% for unruptured aneurysms. The decrease of surgical treatment was most evident in unruptured vertebrobasilar aneurysms (10.8%/year), unruptured communicating artery aneurysms (10.1%/year), ruptured communicating artery aneurysms (10.0%/year), and ruptured internal carotid aneurysms (9.0%/year). There was no change in treatment modality for middle cerebral artery aneurysms, of which 85% were still surgically treated in 2022. A trend towards an increasing size for treated ruptured aneurysms was found (p = 0.033). Conclusion: A significant shift of the treatment modality from surgical to endovascular treatment occurred for all aneurysm locations except for middle cerebral artery aneurysms. Whether this shift has affected long-term safety and patient outcomes should be assessed in the future.
- Subjects
INTRACRANIAL aneurysms; RUPTURED aneurysms; INTRACRANIAL aneurysm ruptures; ENDOVASCULAR surgery; POISSON regression; CEREBRAL arteries
- Publication
Acta Neurochirurgica, 2024, Vol 166, Issue 1, p1
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-024-06064-4