Study Documents 15-Year Interval of Improved Outcomes in Treating Intracranial Aneurysms

February 16, 2016—Michelle H. Chua, BS, et al reported significantly improved outcomes over time for overall intracranial aneurysm management across multiple patient subgroups. The findings are available online ahead of print in Stroke.

According to the investigators, the background of the study is that despite rapid advancements in intracranial aneurysm management, there is no previous evidence that these have translated into improvement in overall prognosis.

As described in Stroke, the investigators looked at both open and endovascular treatments that took place during two periods of aneurysm management, 1998 to 2003 (n = 1,023 aneurysms) and 2007 to 2013 (n = 1,499 aneurysms), at a single, high-volume neurovascular center. The study’s outcome of interest was low or moderate disability (Glasgow Outcome Scale score of 4 or 5) at 6 months or more posttreatment.

The authors, representing the neurosurgical departments at Beth Israel Deaconess Medical Center's Brain Aneurysm Institute and Massachusetts General Hospital, noted significant improvements in outcome for surgical, endovascular, and overall treatment of unruptured aneurysms from the first to the second time period: surgical (adjusted odds ratio [OR], 2.33; P = .0091); endovascular (adjusted OR, 4.40; P = .0271); and overall (adjusted OR, 2.58; P = .0008). There was also significant improvement in outcomes for ruptured aneurysms: surgical (adjusted OR, 3.18; P = .0004); endovascular (adjusted OR, 3.54; P = .0001); and overall (adjusted OR, 3.11; P < .0001). In 2007 to 2013, the proportion of cases with low or moderate disability at 6 months post–subarachnoid hemorrhage was 75.6% for surgical clipping and 76.6% for endovascular therapy, reported the investigators in Stroke.