A survey of intracranial aneurysm treatment practices among United States physicians.
BACKGROUND
Recent surveys have failed to examine cerebrovascular aneurysm treatment practices among US physicians.


OBJECTIVE
To survey physicians who are actively involved in the care of patients with cerebrovascular aneurysms to determine current aneurysm treatment preferences.


METHODS
A 25-question SurveyMonkey online survey was designed and distributed electronically to members of the Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Combined Cerebrovascular Section.


RESULTS
211 physicians completed the survey. Most respondents recommend endovascular treatment as the first-line management strategy for most ruptured (78%) and unruptured (71%) aneurysms. Thirty-eight per cent of respondents indicate that they routinely treat all patients with subarachnoid hemorrhage regardless of grade. Most physicians use the International Study of Unruptured Intracranial Aneurysms data for counseling patients on natural history risk (80%); a small minority (11%) always or usually recommend treatment of anterior circulation aneurysms of <5 mm. Two-thirds of respondents continue to recommend clipping for most middle cerebral artery aneurysms, while most (51%) recommend flow diversion for wide-necked internal carotid artery aneurysms. Follow-up imaging schedules are highly variable. Neurosurgeons at academic institutions and those practicing longer were more likely to recommend clipping surgery for aneurysms (p<0.05).


CONCLUSIONS
This survey demonstrates considerable variability in patient selection for intracranial aneurysm treatment, preferred treatment strategies, and follow-up imaging schedules among US physicians.
Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.
Kyle M
KM
Fargen
Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.
Hector E
HE
Soriano-Baron
Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, North Carolina, USA.
Julia T
JT
Rushing
Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
William
W
Mack
Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
J
J
Mocco
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Felipe
F
Albuquerque
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Andrew F
AF
Ducruet
Departments of Neurology and Neurosurgery, University of Southern Florida, Tampa, Florida, USA.
Maxim
http://orcid.org/0000-0001-7264-4233
M
Mokin
Miami Cardiac and Vascular Institute, Baptist Neuroscience Center, Miami, Florida, USA.
Italo
I
Linfante
Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.
Stacey Q
SQ
Wolfe
Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.
John A
JA
Wilson
Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Joshua A
JA
Hirsch
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000379:methods; D010820:Physicians / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Aneurysm; Coil; Flow Diverter; Subarachnoid