title: Evaluating Imaging Follow-Up Strategies and Costs of Unruptured Intracranial Aneurysms Treated with Endovascular Techniques: A Survey of Academic Neurovascular Centers in the United States.
abstract: BACKGROUND
  Unruptured intracranial aneurysms (UIAs) are being detected and treated with endovascular techniques at an increasing rate, with little evidence on the optimal imaging follow-up protocol. We performed a survey of academic neurovascular centers in the United States to assess imaging follow-up strategies and costs after endovascular treatment of UIAs.
  
  
  METHODS
  An online survey on 5-year follow-up strategies of UIAs treated with endovascular techniques was distributed to neurovascular directors of 101 academic neurovascular centers using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Cerebrovascular Section database. An online healthcare marketplace, NewChoiceHealth, was used to calculate costs.
  
  
  RESULTS
  Of 33 (32.7%) institutions that responded to the survey, 26 (25.7%) provided data suitable for analysis. Nine (34.6%), 10 (38.5%), 4 (15.4%), and 3 (11.5%) centers were located in the northeastern, southern, midwestern, and western regions of the United States. Total costs of 5-year follow-up imaging after primary coil embolization and stent-assisted coiling procedures were $3391-$32,882. Costs for aneurysms treated with flow diversion were $2788-$46,670. Eighteen (69.2%) institutions performed cerebral angiography at 6-month follow-up after coil embolization and stent-assisted coiling, and 19 (73.1%) institutions performed cerebral angiography 6 months after flow diversion. Of institutions, 20% affirmed that they maintained an identical imaging follow-up regimen after treatment of ruptured aneurysms.
  
  
  CONCLUSIONS
  There is significant heterogeneity in imaging follow-up strategies and their associated costs. Stratification of patients by risk of recanalization and corresponding adjustment of follow-up imaging may be 1 strategy to limit unnecessary imaging and control costs.
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Raghav
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nimer
authors.initials: N
authors.lastname: Adeeb
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Chua
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Moore
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Apar S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: cogilvy@bidmc.harvard.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D017542:Aneurysm, Ruptured / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D002532:Intracranial Aneurysm / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D009462:Neurology / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Costs; Endovascular treatment; Follow-up imaging; Unruptured intracranial aneurysms