Introduction: Unruptured intracranial aneurysms (UIAs) are being detected at a greater rate. Advances in endovascular technologies have reduced procedural morbidity and mortality as compared with traditional surgical clipping, in a subset of these cases. Little exists in the literature identifying optimal follow up imaging protocols for these patients. Given recent data which suggests that percent occlusion of the aneurysm at follow up correlates strongly with the rate of rerupture, the utilization of imaging modalities which are both specific and sensitive for aneurysm detection, at the appropriate time points, is essential. Here, the authors provide a summary of the costs of five-year follow up imaging protocols at major academic institutions across the country.
Methods: An online survey was distributed to cerebrovascular departments at major academic centers throughout the US, to assess imaging protocols following endovascular treatment of UIAs.
Results: Twenty-six responses were received. Nine (34.6%) of the centers were located in the northeast and southeast, each, while four were (15.4%) located in the midwest. Two (7.7%) responses, came from centers located in both the west and southwest. Costs for imaging protocols following coil embolization and stent-assisted coiling range from $4,064 to $30,672. For patients treated with flow diversion techniques, these costs ranged from $4,064 to $46,670. Seventeen (65.3%) and eighteen (69.2%) of the institutions perform a cerebral angiogram at 6 month follow up after coil embolization and PED installation, respectively. Twenty percent (5/25) of the respondents reported having different imaging protocol for treated ruptured intracranial aneurysms.
Conclusions: Significant heterogeneity in imaging follow up protocols following endovascular treatment of UIAs, exists across the country, in spite of limited data suggesting the benefit of particular screening regimen in the detection of recanalized aneurysms. There are significant costs associated with these protocols for patients, suggesting the need for further exploration into the optimal regimen.
Patient Care: Endovascular techniques have evolved dramatically over the past couple of decades. Following the publication of the ISAT and ISUIA clinical trials, little literature exists advising physicians as to the time points and imaging modalities that should be used in follow up. Here, we hope to provide a summary of the types of imaging regimen used by academic institutions across the country, and the significant costs associated with each. Given that the rate of rupture is extremely low in most cases, we hope that this analysis will spur discussion as to the appropriate imaging protocol that should be followed, which is both cost-efficient and effective.
Learning Objectives: By the conclusion of this session, participants should be able to (1) Better understand the heterogeneity in follow-up imaging protocols across the country, following endovascular treatment of unruptured intracranial aneurysms (2) Recognize the significant cost to patients associated with follow up imaging, (3) Understand the need to justify the use of either DSA, MRA, and CTA imaging modalities for follow-up given the inherent differences in cost for each of these procedures and the similarities in specificity and sensitivity for detection