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Hemorrhagic Stroke
Original research
Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery
  1. Alice S Wang1,
  2. Jessica K Campos2,
  3. Geoffrey P Colby3,
  4. Alexander L Coon4,
  5. Li-Mei Lin4
  1. 1 Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California, USA
  2. 2 University of California Irvine Medical Center, Orange, California, USA
  3. 3 University of California Los Angeles, Los Angeles, California, USA
  4. 4 Carondelet Neurological Institute, St Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, USA
  1. Correspondence to Dr Li-Mei Lin, Carondelet Neurological Institute, St Joseph's Hospital, 6567 E. Carondelet Drive, Suite 305 Tucson, AZ 85710, USA; drlimeilin{at}gmail.com

Abstract

Background Flow modulation is the newest endovascular technique for treatment of cerebral aneurysms.

Objective To investigate changes in aneurysm treatment practice patterns in the USA.

Methods From the 2007 to 2016, the National Inpatient Sample databases, hospital discharges associated with unruptured aneurysms (UA), and/or ruptured aneurysms (RA) having undergone surgical clipping (SC) and/or endovascular treatments (EVT) were identified using the International Classification of Diseases codes. Patient demographics, hospital characteristics, and clinical outcomes were reviewed. Five year subgroup analyses were performed for treatment differences.

Results A total of 39 282 hospital discharges were identified with a significant increase in EVT (UA: SC n=7847 vs EVT n=12 797, p<0.001; RA: SC n=8108 vs EVT n=10 530, p<0.001). Hospitals in the South demonstrated the most significant EVT use regardless of aneurysm status (UA: SC n=258.5±53.6 vs EVT n=480.7±155.8, p<0.001; RA: SC n=285.6±54.3 vs EVT n=393.3±102.9, p=0.003). From 2007 to 2011, there was no significant difference in the mean number of cases for the treatment modalities (UA: SC n=847.4±107.7 vs EVT n=1120.4±254.1, p=0.21; RA: SC n=949.4±52.8 vs EVT n=1054.4±219.6, p=0.85). Comparatively, from 2012 to 2016, significantly more UA and RA were treated endovascularly (UA: SC n=722.0±43.4 vs EVT n=1439.0±419.2, p<0.001; RA: SC n=672.2±61.4 vs EVT n=1051.6±330.2, p=0.02).

Conclusions As technological innovations continue to advance the neuroendovascular space, the standard of care for treatment of cerebral aneurysms is shifting further towards endovascular therapies over open surgical approaches in the USA.

  • aneurysm
  • flow diverter
  • coil
  • stent

https://doi.org/10.1136/neurintsurg-2019-015702

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    Footnotes

    • Twitter @dralexandercoon, @drlimeilin

    • Correction notice Since the online publication of this article, it was noticed that extra zeros were erroneously added to data during the production process. In the Results section of the Abstract, EVT n=11200.4 has been changed to n=1120.4; n=10540.4 to n=1054.4; n=14390.0 to n=1439.0 and n=10510.6 to n=1051.6. Additionally in the Results section of the article, n=12790.7 has been changed to n=1279.7 and n=10530.0 to n=1053.0.

    • Contributors ASW collected and analyzed the data, drafted the original manuscript, and revised the paper. JKC critically reviewed the paper. GPC and ALC revised the paper. L-ML conceptualized and supervised the study, and revised the paper.

    • Funding This study was partially funded by Western University Summer Research Fellowship Award to ASW.

    • Competing interests GPC is a consultant/proctor for Stryker Neurovascular, MicroVention and Medtronic. ALC is a consultant/proctor for Stryker Neurovascular, Medtronic, and MicroVention, and share holder for InNeuroCo. L-ML is a consultant/proctor for Stryker Neurovascular and a consultant for MicroVention and Cerenovus.

    • Patient consent for publication Not required.

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.