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Original research
Treatment trends and clinical outcomes of endovascular embolization for unruptured intracranial aneurysms in the pediatric population
  1. Alis J Dicpinigaitis1,
  2. Shoaib A Syed2,
  3. Catherine Sillari2,
  4. Johanna T Fifi3,
  5. Jared Pisapia2,4,
  6. Rolla Nuoman2,5,
  7. Chirag D Gandhi2,4,
  8. Fawaz Al-Mufti2,4
    1. 1Department of Neurology, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, New York, USA
    2. 2School of Medicine, New York Medical College, Valhalla, New York, USA
    3. 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
    4. 4Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
    5. 5Department of Neurology, Westchester Medical Center, Valhalla, New York, USA
    1. Correspondence to Dr Fawaz Al-Mufti, Department of Neurology and Neurosurgery, Westchester Medical Center, Valhalla NY 10595, New York, USA; fawaz.al-mufti{at}wmchealth.org

    Abstract

    Background Owing to the relative rarity of unruptured intracranial aneurysms (UIAs) in the pediatric population, evidence regarding treatment modalities and clinical outcomes remains limited.

    Objective To characterize the use and clinical outcomes of endovascular therapy (EVT) and microsurgical clipping (MSC) for pediatric UIAs over a two-decade interval using a large national registry.

    Methods Pediatric (<18 years of age) UIA hospitalizations were identified in the National Inpatient Sample from 2002 to 2019. Temporal use and clinical outcomes were compared for treatment with EVT and MSC.

    Results Among 734 UIAs identified, 64.9% (n=476) were treated with EVT. Use of EVT significantly increased during the study period from 54.3% (2002–2004) to 78.6% (2017–2019) (P=0.002 by Cochrane-Armitage test). In comparison with those treated with MSC, pediatric patients treated with EVT demonstrated higher rates of favorable outcomes (discharge to home without services) (96.0% vs 91.1%, P=0.006), shorter durations of hospital stay (4.6 vs 10.0 days, P<0.001), and lower rates of ischemic or hemorrhagic procedural-related complications (1% vs 4%, P=0.010). Conservative management also increased significantly over the study period (P<0.001 by Cochrane-Armitage test).

    Conclusion A retrospective evaluation of nearly 20 years of population-level data from the United States demonstrates increasing use of EVT for the treatment of pediatric UIAs, with high rates of favorable outcomes and shorter hospital stays in comparison with those treated with microsurgery.

    • Aneurysm
    • Intervention
    • Pediatrics

    Data availability statement

    All diagnosis and procedure codes are included in the manuscript supplement, and data are available upon reasonable request.

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    Data availability statement

    All diagnosis and procedure codes are included in the manuscript supplement, and data are available upon reasonable request.

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    Footnotes

    • X @adicpini, @shoaibsyed123, @almuftifawaz

    • Contributors FA-M and AD conceived the project and devised the methodology. AD completed statistical analysis. AD, SS, and CS composed the first complete draft of the manuscript. All authors evaluated the data and contributed to revising the manuscript draft. All authors read and approved the final version of the manuscript. FA-M, JTF, and CDG provided supervision for the project. AJD acts as a guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.