scholarly journals Validation of the unruptured intracranial aneurysm treatment score: comparison with real-world cerebrovascular practice

2018 ◽  
Vol 129 (1) ◽  
pp. 100-106 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Adam de Havenon ◽  
Timothy C. Gooldy ◽  
Jonathan Scoville ◽  
Jian Guan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Real World ◽  
Roc Curve ◽  
Academic Medical Center ◽  
Treatment Recommendation ◽  
Unruptured Intracranial Aneurysm ◽  
The Real ◽  
Aneurysm Treatment ◽  
Unruptured Intracranial Aneurysms ◽  
Sensitivity Specificity

OBJECTIVEThe purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs).METHODSAll patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS. Patients were categorized in a contingency table assessing UIATS recommendation versus real-world treatment decision. The authors calculated the percentage of misclassification, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve.RESULTSA total of 221 consecutive patients with UIAs met the inclusion criteria: 69 (31%) patients underwent treatment and 152 (69%) did not. Fifty-nine (27%) patients had a UIATS between −2 and 2, which does not offer a treatment recommendation, leaving 162 (73%) patients with a UIATS treatment recommendation. The UIATS was significantly associated with treatment (p < 0.001); however, the sensitivity, specificity, and percentage of misclassification were 49%, 80%, and 28%, respectively. Notably, 51% of patients for whom treatment would be recommended by the UIATS did not undergo treatment in the real-world cohort and 20% of patients for whom conservative management would be recommended by UIATS had intervention. The area under the ROC curve was 0.646.CONCLUSIONSCompared with the authors’ experience, the UIATS recommended overtreatment of UIAs. Although the UIATS could be used as a screening tool, individualized treatment recommendations based on consultation with a cerebrovascular specialist are necessary. Further validation with longitudinal data on rupture rates of UIAs is needed before widespread use.

scholarly journals P.051 Validation of the unruptured intracranial aneurysm treatment score against “real-world” MDT decisions

2017 ◽  
Vol 44 (S2) ◽  
pp. S26-S26
Author(s):  
H Godbout ◽  
J Jarrett ◽  
GE Pickett
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Outcomes ◽  
Real World ◽  
Aneurysm Rupture ◽  
Case Control Studies ◽  
Clinical Tool ◽  
Unruptured Intracranial Aneurysm ◽  
Aneurysm Treatment ◽  
Elective Treatment ◽  
Aneurysm Repair

Background: Intracranial aneurysms are relatively common and often incidentally detected. Elective treatment may eliminate the risk of future hemorrhage, but carries risks of permanent deficit or death. Case-control studies have suggested factors predisposing to aneurysm rupture as well as risks of elective aneurysm repair. A clinical tool was recently developed to weigh benefits of repair against treatment risks. We evaluate its performance against real-world clinical decisions made by a cerebrovascular multidisciplinary team (MDT). Methods: Chart review of all patients with unruptured intracranial berry aneurysms (UIA) discussed at cerebrovascular MDT rounds 2008-2015. Management decisions and clinical outcomes were recorded. The Unruptured Intracranial Aneurysm Treatment Score (UIATS) was calculated for each patient (each aneurysm in the case of multiple UIA). Results: We identified 240 patients with a total of 279 aneurysms. UIATS recommended aneurysm repair in 79 cases, conservative management in 88 cases, and was equivocal in 112 cases. Where the UIATS gave a clear decision, that decision was concordant with the MDT decision in 119/167 cases (71%). Discordant decisions often related to the presence of comorbidities. Clinical outcomes did not differ in cases where the recommendations were clearly concordant vs. discordant. Conclusions: The UIATS may provide guidance to non-expert clinicians. It did not outperform the MDT.

Abstract WP120: Readmission Trends Related to Unruptured Intracranial Aneurysm Treatment

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Tapan Mehta ◽  
Smit Patel ◽  
Shailesh Male ◽  
Andrew Zhang ◽  
Adam Khan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Unruptured Intracranial Aneurysm ◽  
Aneurysm Treatment

scholarly journals P.114 Headache outcomes after treatment of unruptured intracranial aneurysms: systematic review and meta-analysis

2019 ◽  
Vol 46 (s1) ◽  
pp. S43-S44
Author(s):  
C Dandurand ◽  
H Parhar ◽  
F Naji ◽  
S Prakash ◽  
PA Gooderham
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Rating Scale ◽  
Meta Analysis ◽  
Effect Estimate ◽  
Significant Heterogeneity ◽  
Unruptured Intracranial Aneurysm ◽  
Standard Mean Difference ◽  
Unruptured Intracranial Aneurysms

Background: Headaches are a major cause of disability and healthcare cost worldwide. When investigating headaches etiology, incidental unruptured intracranial aneurysms are often considered unrelated. We conducted a systematic review and meta-analysis to assess headaches outcomes (severity) after treatment of unruptured intracranial aneurysm. Methods: MEDLINE and EMBASE were systematically reviewed. Results: The data from eligible studies (n=7) was extracted and analyzed. 309 nonduplicated patients provided patient-level data for analysis. All studies used the 10-point numeric rating scale (NRS). 88% of patients were treated with endovascular technique. Overall, the observed effect estimate under a random effects model was found to be a standard mean difference in pre- and post-intervention headache severity of -0.448 (95% CI: -0.566 to -0.329). No significant heterogeneity was noted. No significant publication bias was demonstrated. Conclusions: This is the first and largest systematic review assessing postoperative headache outcomes after treatment of unruptured intracranial aneurysm. A significant reduction in headache intensity after treatment is observed in the current published literature. This study highlights an interesting clinical phenomenon that still warrants scientific effort before it can influence clinical practice. We encourage future study to stratify headache outcomes by aneurysm size, location and treatment modality.

scholarly journals The unruptured intracranial aneurysm treatment score

Neurology ◽  
2015 ◽  
Vol 85 (10) ◽  
pp. 881-889 ◽  
Author(s):  
Nima Etminan ◽  
Robert D. Brown ◽  
Kerim Beseoglu ◽  
Seppo Juvela ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Unruptured Intracranial Aneurysm ◽  
Aneurysm Treatment

scholarly journals Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?

2016 ◽  
Vol 9 (8) ◽  
pp. 756-760 ◽  
Author(s):  
William R Stetler ◽  
Julius Griauzde ◽  
Yamaan Saadeh ◽  
Thomas J Wilson ◽  
Wajd N Al-Holou ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Coil Embolization ◽  
Multivariate Regression ◽  
Intracranial Aneurysms ◽  
Cost Savings ◽  
Multivariate Regression Analysis ◽  
Unruptured Intracranial Aneurysm ◽  
Icu Admission ◽  
Telemetry Unit ◽  
Unruptured Intracranial Aneurysms

IntroductionPatients with an unruptured intracranial aneurysm treated with coil embolization are routinely admitted to the intensive care unit (ICU) after the procedure; however, this practice is questionable. The purpose of this study was to determine if routine admission to the ICU is necessary for patients undergoing coil embolization of an unruptured intracranial aneurysm.MethodsWe conducted a retrospective cohort study of all patients undergoing elective endovascular treatment of an unruptured intracranial aneurysm between 2005 and 2012 at our institution. Multivariate regression analysis was performed to identify predictors of outcome. Cost savings analysis compared ICU admission to step-down or telemetry unit admission.Results311 unruptured intracranial aneurysms were treated by coil embolization (190), balloon remodeling (13), or stent-assisted coiling (108). Eleven (3.5%) neurologic complications were noted; 5 (1.6%) of these were permanent. Multivariate regression analysis identified female sex (p=0.028), hypercoagulability (p=0.021), aneurysm size >2 cm (p=0.003), and intraoperative rupture (p<0.001) as predictors of a post-procedural neurologic complication. Cost savings were 57% for admission to a step-down unit and 32% for admission to a telemetry unit compared with ICU admission.ConclusionsNeurologic complications are rare in the treatment of unruptured intracranial aneurysms, suggesting that routine ICU admission after treatment may not be necessary. Female sex, history of hypercoagulability, aneurysm size >2 cm, and an intraprocedural rupture were predictive of a postoperative complication. ICU monitoring in these subgroups may therefore be warranted.

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