Introduction: The management of intracranial aneurysms (IAs) has changed over the last decade due to several factors, namely the rise of endovascular techniques, increased frequency of intracranial imaging and number of hospitals treating IAs. Several recent publications have emerged utilizing national databases describing these trends in the management of IAs. However, these databases often only involve either all-payers, are random samples, or only based on ICD-9 codes, which is error prone. We present our institutional experience treating IAs over a 10-year period, including treatment strategy trends and the impact of endovascular treatment.
Methods: The UT Southwestern Medical Center maintains an IRB-approved database containing patients with intracranial aneurysms. We examined all treated IAs, both ruptured and unruptured, during the period of 2000-2009.
Results: During the years 2000-2009, 2236 intracranial aneurysms were treated at UTSW and the annual number increased from 153 in 2000 to 262 in 2009. The number of ruptured IAs remained steady (64 [2000] and 57 [2009]) through the decade while the number of unruptured IAs increased from 89 in 2000 to 205 in 2009. Treatment strategies remained roughly equal between microsurgery and endovascular strategies for ruptured IAs but endovascular strategies increased for unruptured IAs (8% [2000] and 47% [2009]). The percentage of treated ruptured cases has been on a downward trend (42% [2000] versus 22% 2009]) while the percentage of unruptured cases has increased (58% [2000] versus 78% [2009]). While endovascular treatment of ruptured IAs has made modest gains (1.6% [2000] versus 21% [2009]), it has almost equaled that of microsurgery for unruptured lesions (8% [2000] versus 44% [2009]).
Conclusions: While endovascular treatment of unruptured IAs has made tremendous gains, endovascular treatment of unruptured has only made modest gains. Further, the numbers of treated unruptured IAs has increased significantly while ruptured IAs have remained largely unchanged.
Patient Care: Knowledge of management trends in intracranial aneurysms may allow practitioners to make better informed decisions regarding the best modality of treatment to consider first line.
Learning Objectives: By the conclusion of this session, participants should be able to:
Describe the current trends in treatment strategies of intracranial aneurysms, both ruptured and unruptured lesions.