Introduction The neuroendovascular space continues to evolve with innovative devices. Flow diversion is the newest endovascular technique for cerebral aneurysm treatments since Food and Drug Administration (FDA) approval in 2011. We conducted a national database study to investigate any change in clinical practice patterns.
Methods United States National Inpatient Sample (NIS) databases from 2007 to 2016 were queried for hospital discharges with unruptured aneurysm (UA) and/or ruptured aneurysm (RA) patients receiving surgical clipping (SC) and/or endovascular treatments (EVT) using the International Classification of Diseases (ICD) Ninth Revision-Clinical Modification (CM), ICD Tenth Revision-CM, and ICD Tenth Revision-Procedure Coding System. Patient demographics, hospital characteristics and clinical outcomes were reviewed. Sub-group analysis was performed for treatment differences in 2007–2011 versus (vs.) 2012–2016 timeframes.
Results A total of 39,282 hospital discharges were identified with significant increase in EVT (UA: SC n=7,847 vs. EVT n=12,797, p<0.001; RA: SC n=8,108 vs. EVT n=10,530, p<0.001). Hospitals in the South demonstrated the most significant EVT use irregardless 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 2007–2011, 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=1,120.4 ± 254.1, p=0.21; RA: SC n=949.4 ± 52.8 vs. EVT n=1,054.4 ± 219.6, p=0.85). The 2012–2016 period demonstrated significant increase in mean number of cases treated endovascularly for both UA and RA (UA: SC n=722.0 ± 43.4 vs. EVT n=1,439.0 ± 419.2, p<0.001; RA: SC n=672.2 ± 61.4 vs. EVT n=1,051.6 ± 330.2, p=0.02).
Conclusions As technological innovations continue to advance the neuroendovascular space, the standard of care for cerebral aneurysm treatments further shift towards endovascular therapies over open surgical approaches in the United States.
Disclosures A. Wang: 1; C; Western University Summer Research Fellowship Award. J. Campos: None. G. Colby: 2; C; Stryker Neurovascular, Medtronic. A. Coon: 2; C; Stryker Neurovascular, Medtronic, MicroVention. 4; C; InNeuroCo. L. Lin: 2; C; Stryker Neurovascular, MicroVention, Cerenovus.
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