RT Journal Article
SR Electronic
T1 E-071 Beyond coiling: a comparative analysis of neuro-interventionalist preferences for aneurysm occlusion
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP A124
OP A125
DO 10.1136/jnis-2024-SNIS.176
VO 16
IS Suppl 1
A1 Salwi, S
A1 Tudor, T
A1 Shekhtman, O
A1 Sioutas, G
A1 Matache, I
A1 Salem, M
A1 Corral Tarbay, A
A1 Ajmera, S
A1 Kandregula, S
A1 Burkhardt, J
A1 Srinivasan, V
YR 2024
UL http://jnis.bmj.com/content/16/Suppl_1/A124.abstract
AB Background Aneurysm treatment options are rapidly involving with the introduction of flow diversion and intra-saccular devices. Prior studies have explored interventionalist preferences for more general surgical vs. endovascular intervention. However, it is unknown how interventionalists decide between various endovascular options for difficult-to-treat aneurysms.Methods A survey-based study was conducted to investigate the variation in treatment recommendations for ruptured and unruptured aneurysms among neurosurgeons, neurologists, and radiologists. Participants were presented with clinical vignettes and asked to choose preferred treatment options. Then responses analyzed based on standard clinician and practice specific variables. We additionally explored how training prior to and after the introduction of flow diverters affected the decision to use these devices.Results A total of 108 respondents completed the study with a representative mix of specialties - (45 (42.5%) radiologists, 22 (20.8%) neurologists, and 39 (36.8%) neurosurgeons). The majority of physicians (n = 66, 61.1%) trained after the introduction of flow diversion so ostensibly learned to use these in fellowship. Notably, treatment recommendations when looking at the answers to all questions in aggregate were significantly different by specialty (p <0.001). The agreement between respondents for treating ruptured v unruptured and anterior v posterior aneurysms was overall poor (K=0.07) to fair (0.21) highlighting the significant variation in practice. Treatment of ruptured aneurysms varied by specialty with radiologists opting for stent assisted coiling at a higher rate than neurologists or neurosurgeons (p <0.001). There was no significant difference in rates of recommending flow diversion or intrasaccular devices between those that had trained before and after their introduction (p = 0.97). Likely interventionalists are a self-selecting group of people that are early adopters of new technology with the comfort and desire to incorporate these into their practice. Training at a time when these devices were not yet in use did not deter them from considering these techniques for aneurysm occlusion. This dynamism is reflected throughout the field as new devices and techniques are rapidly tested and adopted.Conclusion The study highlights the dynamic nature of aneurysm management and considerable variability among different specialties.View this table:Abstract E-071 Table 1 Top four treatment recommendations for ruptured aneurysm occlusion stratified by specialtyAbstract E-071 Figure 1 Disclosures S. Salwi: None. T. Tudor: None. O. Shekhtman: None. G. Sioutas: None. I. Matache: None. M. Salem: None. A. Corral Tarbay: None. S. Ajmera: None. S. Kandregula: None. J. Burkhardt: None. V. Srinivasan: None.