title: Documentation of Improved Outcomes for Intracranial Aneurysm Management Over a 15-Year Interval.
abstract: OBJECTIVE
  Despite rapid advancements in intracranial aneurysm management, there is no evidence as of yet that this has translated into improvement in overall prognosis.
  
  
  METHODS
  We compared 2 periods of aneurysm management, 1998 to 2003 (n=1023 aneurysms) and 2007 to 2013 (n=1499 aneurysms), at a single, high-volume neurovascular center. Our outcome of interest was low or moderate disability (Glasgow Outcome Scale score of 4 or 5) at 6 months or more post treatment.
  
  
  RESULTS
  There were significant improvements in outcome for surgical, endovascular, and overall treatment of unruptured (adjusted odds ratio [OR], 2.33; P=0.0091; adjusted OR, 4.40; P=0.0271; and adjusted OR, 2.58; P=0.0008, respectively) and ruptured (adjusted OR, 3.18; P=0.0004; adjusted OR, 3.54; P=0.0001; and adjusted OR, 3.11; P<0.0001, respectively) aneurysms from the first to the second time period. 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.
  
  
  CONCLUSIONS
  We report significantly improved outcomes over time for overall aneurysm management and for multiple patient subgroups, associated with increased usage of endovascular therapy.
authors.affiliation: From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, MA (M.H.C., C.J.G., L.H., A.J.T., C.S.O.); and Department of Neurosurgery, Massachusetts General Hospital, Boston (C.J.S.).
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Chua
authors.affiliation: From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, MA (M.H.C., C.J.G., L.H., A.J.T., C.S.O.); and Department of Neurosurgery, Massachusetts General Hospital, Boston (C.J.S.).
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, MA (M.H.C., C.J.G., L.H., A.J.T., C.S.O.); and Department of Neurosurgery, Massachusetts General Hospital, Boston (C.J.S.).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stapleton
authors.affiliation: From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, MA (M.H.C., C.J.G., L.H., A.J.T., C.S.O.); and Department of Neurosurgery, Massachusetts General Hospital, Boston (C.J.S.).
authors.forename: Lucy
authors.initials: L
authors.lastname: He
authors.affiliation: From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, MA (M.H.C., C.J.G., L.H., A.J.T., C.S.O.); and Department of Neurosurgery, Massachusetts General Hospital, Boston (C.J.S.).
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, MA (M.H.C., C.J.G., L.H., A.J.T., C.S.O.); and Department of Neurosurgery, Massachusetts General Hospital, Boston (C.J.S.). cogilvy@bidmc.harvard.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
mesh_terms: D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Glasgow Outcome Scale; endovascular techniques; intracranial aneurysms; outcomes research; surgical instruments