Cost Comparison of Surgical and Endovascular Treatment of Unruptured Giant Intracranial Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 77 (5) ◽  
pp. 733-743 ◽  
Author(s):  
◽  
Pietro Familiari ◽  
Nicolai Maldaner ◽  
Adisa Kursumovic ◽  
Stefan A. Rath ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Direct Costs ◽  
Treatment Costs ◽  
Cost Comparison ◽  
Treatment Groups ◽  
Giant Intracranial Aneurysms ◽  
Hospital Stays

Abstract BACKGROUND: Giant intracranial aneurysms (GIAs), which are defined as intracranial aneurysms (IAs) with a diameter of ≥25 mm, are most likely associated with the highest treatment costs of all IAs. However, the treatment costs of unruptured GIAs have so far not been reported. OBJECTIVE: To examine direct costs of endovascular and surgical treatment of unruptured GIAs. METHODS: We retrospectively examined 55 patients with unruptured GIAs treated surgically (37 patients) or endovascularly (18 patients) between April 2004 and March 2014. We analyzed the costs of all hospital stays, interventions, and imaging with a median follow-up of 46 months. RESULTS: There was no difference in the costs of hospital stay between surgical and endovascular treatment groups ($10 565 vs $14 992; P = .37). Imaging costs were significantly higher in the surgical group than in the endovascular treatment group ($2890 vs $1612; P < .01), as were the costs of the intervention room and personnel involved in the intervention ($5566 vs $1520; P < .01). Implants used per patient were more expensive in the endovascular group than in the surgical treatment group ($20 885 vs $167). The total direct treatment costs were higher in the endovascular group ($52 325) than in the surgical treatment group ($20 619; P < .01). Treatment costs were associated with the type of treatment and GIA location but not with patient age, sex, or GIA size. CONCLUSION: Endovascular GIA treatment produced higher direct costs than surgical GIA treatment mainly due to higher implant costs. Reducing endovascular implant costs may be the most effective tool to decrease direct costs of GIA treatment.

scholarly journals Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms - A Systematic Review and Meta-Analysis

2016 ◽  
Vol 41 (3-4) ◽  
pp. 187-198 ◽  
Author(s):  
Julius Dengler ◽  
Nicolai Maldaner ◽  
Sven Gläsker ◽  
Matthias Endres ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Separate Analysis ◽  
Patient Age ◽  
Good Outcome ◽  
Giant Intracranial Aneurysms ◽  
Patient Âgé

Background: Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. Methods: Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model. Results: We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. Conclusions: We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.

scholarly journals The effects of surgical treatment and sclerotherapy for intramuscular venous malformations: a comparative clinical study

2021 ◽  
Vol 48 (6) ◽  
pp. 622-629
Author(s):  
Yun Hyun Kim ◽  
Jeong Yeop Ryu ◽  
Joon Seok Lee ◽  
Seok Jong Lee ◽  
Jong Min Lee ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Clinical Outcomes ◽  
Vascular Malformations ◽  
Medical Center ◽  
Surgical Excision ◽  
Complication Rates ◽  
Venous Malformations ◽  
Treatment Groups ◽  
Comparative Clinical Study

Background Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision.Methods Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement.Results Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group.Conclusions Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.

Abstract 3956: Outcomes of Patients Undergoing Endovascular Treatment for Mycotic Intracranial Aneurysms

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Saqib A Chaudhry ◽  
M Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Multivariate Logistic Regression Analysis ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Hospital Outcomes ◽  
Aneurysm Wall ◽  
Mycotic Aneurysms

Background: Mycotic intracranial aneurysms are rare with primary treatment focusing on underlying infection to reduce the high mortality rates. Treating these aneurysms remains challenging and obliteration procedures without sacrificing the parent artery often fail due to the fusiform and fragile aneurysm wall. Objective: To determine the outcomes associated with endovascular embolization in patients with mycotic intracranial aneurysms using a large nationally representative sample. Methods: We determined the frequency of endovascular and surgical procedures performed in patients with mycotic intracranial aneurysms and associated in-hospital outcomes using data from the Nationwide Inpatient Survey (NIS) data files from 2002 to 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate logistic regression analysis. Results: Of the 1,915 patients admitted with the diagnosis of infected “mycotic” aneurysms, 83 (4.3%) underwent endovascular embolization, and 59 (3.1%) underwent surgical treatment. In mycotic aneurysms treated with endovascular treatment compared to surgical treatment, discharge outcomes were better with higher rates of minimal disability self-care (40% vs. 23.7% p=0.2436), and lower rates of moderate-severe disability (36% vs. 40% p=0.7874), and in-hospital deaths death (22.9 vs. 35.2 p= 0.3608). After adjusting for age, gender, and hospital teaching status, discharge mortality after endovascular treatment was not inferior to surgical treatment (odds ratio [OR] 1.58, 95% confidence interval [CI] 0.14 - 17.9) or those treated medically (OR 0.56, 95% CI 0.132 - 2.36). Conclusion: Endovascular embolization for mycotic intracranial aneurysms provides comparable outcomes to surgical treatment and should be considered whenever feasible when aneurysm obliteration is indicated.

CHALLENGES IN THE ENDOVASCULAR TREATMENT OF GIANT INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_3) ◽  
pp. S3-113-S3-124 ◽  
Author(s):  
Nestor R. Gonzalez ◽  
Gary Duckwiler ◽  
Reza Jahan ◽  
Yuichi Murayama ◽  
Fernando Viñuela
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Giant Intracranial Aneurysms

ENDOVASCULAR TREATMENT OF GIANT INTRACRANIAL ANEURYSMS WITH WILLIS COVERED STENTS

Neurosurgery ◽  
2008 ◽  
Vol 62 (5) ◽  
pp. E1176-E1177 ◽  
Author(s):  
Jian B. Wang ◽  
Ming H. Li ◽  
Chun Fang ◽  
Wu Wang ◽  
Ying S. Cheng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Covered Stents ◽  
Giant Intracranial Aneurysms

scholarly journals Endovascular Treatment of Giant Intracranial Aneurysms

Cureus ◽  
2020 ◽  
Author(s):  
Italo Linfante ◽  
Vincenzo Andreone ◽  
Natalia Ravelo ◽  
Amy K Starosciak ◽  
Bilal Arif ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Giant Intracranial Aneurysms

Abstract 108: Long-Term Outcome of Giant Unruptured Intracranial Aneurysms

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
James C Torner ◽  
David Piepgras ◽  
John Huston ◽  
Irene Meissner ◽  
Robert Brown
Keyword(s):  
High Risk ◽  
Endovascular Treatment ◽  
Prospective Cohort ◽  
Intracranial Aneurysms ◽  
Smoking History ◽  
Maximum Diameter ◽  
Giant Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Introduction: Giant intracranial aneurysms are uncommon, have a high risk for rupture and are difficult to treat. The International Study of Unruptured Intracranial Aneurysms (ISUIA) prospective cohort included 187 patients with maximal diameter of 25 mm or greater. This analysis was to determine the long-term prognosis of these aneurysms both treated and untreated. Methods: Patients were enrolled into ISUIA at 61 centers from 1991-1998. A prospective cohort included the managed with observation, surgery or endovascular treatment. Patients were followed for a median of 9.2 years. Aneurysms were measured using a central reading of bi-planar cerebral angiography. Outcomes were determined prospectively and with central review. Results: 187 patients with a maximum diameter of 25 mm were followed. The mean size was 30.3 mm, ranging from 25 to 63 mm. 39% of the aneurysms were surgically treated at baseline, 27% were endovascularly treated, and 32% were managed conservatively;3% had subsequent endovascular treatment and 5% surgical treatment. Patients with giant aneurysms were predominantly women (83%), had a baseline Rankin Score of in 93%, were located predominantly in the anterior circulation (internal carotid 44%, cavernous ICA 28%, middle cerebral 12%). 80% of the patients were symptomatic with cranial nerve deficit in 47% (III and VI nerves), mass effect in 16%, headaches in 44%, orbital pain in 21%, and vision loss in 25%. Smoking history was present in 67%, hypertension in 44%, vascular headaches in 29% and family history in 10%. 70 patients (39%) died during follow-up however 59% were still Rankin 1 or 2. Both surgical and endovascular treated patients had 60-64% good outcome and 34-36% mortality. Untreated patients had a 57% mortality. Subarachnoid hemorrhage occurred in 11 untreated patients and 12 treated patients with most occurring in the first year. Conclusions: Giant intracranial aneurysms are typically symptomatic, and have a high risk of rupture early after diagnosis. Outcome was similar with surgical and endovascular treatment but post-procedure hemorrhage did occur.

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