Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Abstract

Objective Treatment modality for ruptured and unruptured intracranial aneurysms has shifted during the last two decades from microsurgical treatment towards endovascular treatment. We present how this transition happened in a large European neurovascular center. Methods We conducted a retrospective observational study consecutive patients treated for an unruptured or ruptured intracranial aneurysm at Helsinki University Hospital during 2012–2022. We used Poisson regression analysis to report age-adjusted treatment trends by aneurysm location and rupture status. Results A total of 2491 patients with intracranial aneurysms were treated (44% ruptured, 56% unruptured): 1421 (57%) surgically and 1070 (43%) endovascularly. A general trend towards fewer treated aneurysms was noted. The proportion of patients treated surgically decreased from 90% in 2012 to 20% in 2022. The age-adjusted decrease of surgical versus endovascular treatment was 6.9%/year for all aneurysms, 6.8% for ruptured aneurysms, and 6.8% for unruptured aneurysms. The decrease of surgical treatment was most evident in unruptured vertebrobasilar aneurysms (10.8%/year), unruptured communicating artery aneurysms (10.1%/year), ruptured communicating artery aneurysms (10.0%/year), and ruptured internal carotid aneurysms (9.0%/year). There was no change in treatment modality for middle cerebral artery aneurysms, of which 85% were still surgically treated in 2022. A trend towards an increasing size for treated ruptured aneurysms was found (p = 0.033). Conclusion A significant shift of the treatment modality from surgical to endovascular treatment occurred for all aneurysm locations except for middle cerebral artery aneurysms. Whether this shift has affected long-term safety and patient outcomes should be assessed in the future.

Improved rates of postoperative ischemia, completeness of aneurysm occlusion and neurological deficits in elective clipping of anterior circulation aneurysms over the past 20 years – association with technical improvements

“…Furthermore, endovascular approaches expanded in the last few years and simultaneously the proportion of surgically treated aneurysm shifted towards a higher proportion of aneurysms with a complex configuration which was mostly true for posterior circulation aneurysms, while this trend was markedly lower for anterior circulation aneurysms like MCA aneurysm as outlined in previous publications [ 4 , 13 , 37 ]. We could also see this development with a relative overall shift towards endovascular repair in our institute during the study period (as outlined in Fig.…”

Geometry and Symmetry of Willis’ Circle and Middle Cerebral Artery Aneurysms Development

“…Our study explored the potential role of the main anatomic variations of the Willis circle as a risk factor for MCA aneurysm formation and rupture. The importance of this subject is given by the fact that the recognition of a relationship between the geometry and symmetry of the circle of Willis and the presence of aneurysms or their risk of rupture has a clinical impact in the planning of screening and follow-up protocols, especially in an era in which non-invasive neuroimaging diagnostics are extremely widespread and the detection of incidental aneurysms is continuously increasing [22].…”

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

“…Microsurgical clipping has been the standard treatment for intracranial aneurysms. However, endovascular approaches including coil embolization have become crucial alternatives due to their minimally invasive nature and proven long-term efficacy in preventing aneurysm rupture [ 1 , 2 , 3 , 4 ]. Despite advancements in endovascular devices, such as flow diverter stents, coil embolization remains vital for promoting intra-aneurysmal thrombosis and reducing rupture risk.…”