Cerebral Aneurysms: Analyzing the Treatment Shift

Ruptures of cerebral aneurysms lead to subarachnoid hemorrhage (SAH) and are associated with substantial mortality and morbidity. Previous research has indicated that the rupture rates of aneurysms vary with size, location, and morphological characteristics, as well as patients’ personal and family medical history. “These variables have historically been used to help guide the clinical management of cerebral aneurysms,” explains Robert M. Friedlander, MD. “For clinicians who treat these patients, microsurgical clipping and endovascular coiling have emerged as the two primary interventions for cerebral aneurysms that require intervention.” In 2002, outcomes for patients with ruptured cerebral aneurysms were reported in the International Subarachnoid Aneurysm Trial (ISAT). The trial compared mortality and clinical outcomes of patients with aneurysmal SAH who were treated with either surgical clipping or endovascular coiling. The study found that patients who underwent coiling had lower mortality and better outcomes at 1 year than those who had open surgery. As a result of the ISAT findings, it was assumed that more clinicians in the United States would begin treating ruptured aneurysms with endovascular approaches. “Sufficient time has now passed since the publication of the ISAT results to allow for a formal examination of treatment patterns for cerebral aneurysms—both ruptured and unruptured—within the U.S.,” says Dr. Friedlander. “It’s important to analyze trends on the use of endovascular coiling because patterns may be different in demographic subgroups and in hospitals located in different geographic areas.” Recent Trends in Cerebral Aneurysm Treatment In the May 2012 Journal of Neurointerventional Surgery, Dr. Friedlander, Ning Lin, MD, and colleagues published an analysis describing patterns of use and in-hospital mortality associated with surgical and...