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Original research
A survey of intracranial aneurysm treatment practices among United States physicians
  1. Kyle M Fargen1,
  2. Hector E Soriano-Baron1,
  3. Julia T Rushing2,
  4. William Mack3,
  5. J Mocco4,
  6. Felipe Albuquerque5,
  7. Andrew F Ducruet5,
  8. Maxim Mokin6,
  9. Italo Linfante7,
  10. Stacey Q Wolfe1,
  11. John A Wilson1,
  12. Joshua A Hirsch8
  1. 1Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  2. 2Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, North Carolina, USA
  3. 3Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
  4. 4Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
  5. 5Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  6. 6Departments of Neurology and Neurosurgery, University of Southern Florida, Tampa, Florida, USA
  7. 7Miami Cardiac and Vascular Institute, Baptist Neuroscience Center, Miami, Florida, USA
  8. 8Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Kyle M Fargen, Department of Neurological Surgery, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; kfargen{at}


Background Recent surveys have failed to examine cerebrovascular aneurysm treatment practices among US physicians.

Objective To survey physicians who are actively involved in the care of patients with cerebrovascular aneurysms to determine current aneurysm treatment preferences.

Methods A 25-question SurveyMonkey online survey was designed and distributed electronically to members of the Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Combined Cerebrovascular Section.

Results 211 physicians completed the survey. Most respondents recommend endovascular treatment as the first-line management strategy for most ruptured (78%) and unruptured (71%) aneurysms. Thirty-eight per cent of respondents indicate that they routinely treat all patients with subarachnoid hemorrhage regardless of grade. Most physicians use the International Study of Unruptured Intracranial Aneurysms data for counseling patients on natural history risk (80%); a small minority (11%) always or usually recommend treatment of anterior circulation aneurysms of <5 mm. Two-thirds of respondents continue to recommend clipping for most middle cerebral artery aneurysms, while most (51%) recommend flow diversion for wide-necked internal carotid artery aneurysms. Follow-up imaging schedules are highly variable. Neurosurgeons at academic institutions and those practicing longer were more likely to recommend clipping surgery for aneurysms (p<0.05).

Conclusions This survey demonstrates considerable variability in patient selection for intracranial aneurysm treatment, preferred treatment strategies, and follow-up imaging schedules among US physicians.

  • Aneurysm
  • Coil
  • Flow Diverter
  • Subarachnoid

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  • Contributors Study conception and design (JAH, KMF). Societal support and data collection (KMF, WM, JM, FA, AFD, MM, IL, JAH, JAW, SQW). Statistics (KMF, JTR). Manuscript composition (KMF, HES-B). All authors reviewed the manuscript, provided critical review, and provided final approval of the manuscript to be published.

  • Competing interests None declared.

  • Ethics approval Wake Forest institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data.