National Trends in the Treatment of Ruptured Cerebral Aneurysms in Korea Using an Age-adjusted Method

Abstract

Background: Two primary treatment methods are used for ruptured cerebral aneurysms, surgical clipping and endovascular coiling. In recent decades, endovascular coiling has shown remarkable progress compared to surgical clipping, along with technological developments. The aim of this study was to investigate the recent trends in treatments for ruptured cerebral aneurysms in Korea. Methods: The data were obtained from the National Health Insurance database. We evaluated the trends in endovascular coiling and surgical clipping for ruptured aneurysms for the period 2000-2017. We obtained the number of prescriptions with International Classification of Diseases, 9th Revision, clinical modification codes related to nontraumatic subarachnoid hemorrhage and prescription codes S4641/4642 for surgical clipping and M1661/1662 for endovascular coiling. The medical expenses for each prescription were also obtained. The primary outcomes included the cumulative number of patients, patient rates per 100,000 people, and the correlation between patient rates and the percentage of the population in each age group. Results: In the case of surgical clipping, there were no increasing or decreasing trends in the cumulative number of patients when the population/age group was ignored. When examining the trends in patient rates per 100,000 population at each year in male, there was no increasing or decreasing trend in the number of surgical clippings between the age groups, in spite of a decreasing tendency in the number of surgical clipping in male in their 40s and older than 60. In females, the surgical clipping rates tended to decrease only in patients older than 60 years, but there was no tendency to increase or decrease in the other ages. In contrast, the cumulative number of patients who underwent endovascular coiling for ruptured cerebral aneurysms increased year by year regardless of the population/age group. In both male and female, there was no increasing or decreasing trend only in the group aged 40 or younger and there was an increasing tendency in the rest of the age groups. In the trend of medical expenses, both the cost of surgical clipping and endovascular coiling showed increases. Specifically, the medical expense trend in endovascular coiling increased more rapidly than that for surgical clipping. Conclusion: There was a significant increase in the proportion of patients with ruptured aneurysms undergoing endovascular coiling between 2010 and 2017, whereas the use of surgical clipping decreased. The endovascular coiling was significantly increased in all age groups and surgical clipping was decreased in all age groups, especially in patients under 50 years of age.

Endovascular trends in the treatment of intracranial aneurysms in a Peruvian reference center

“…We did not find an increase in the EVT of ruptured aneurysms, similar to the findings of previous publications. [ 4 , 6 , 14 , 18 , 19 ] This determined that our institution receives a constant number of ruptured cases during this period, and this finding may be used as a public health indicator for possible screening and post-operative rehabilitation. According to the location, we determined that the most frequent aneurysm was found in the posterior communicating artery segment of the ICA, which in turn is the most frequent aneurysm in our population.…”

“…We found that EVT of unruptured IAs increased, which is the trend found in previous publications. [ 4 , 7 , 8 , 14 ] In this scenario, better clinical outcomes and a shorter length of in-hospital stay are the main advantages of this treatment modality. [ 7 , 15 , 16 ] However, long-term durability of the embolization remains unclear, [ 14 ] specially when only primary coiling is employed as the main technique.…”

“…[ 4 , 7 , 8 , 14 ] In this scenario, better clinical outcomes and a shorter length of in-hospital stay are the main advantages of this treatment modality. [ 7 , 15 , 16 ] However, long-term durability of the embolization remains unclear, [ 14 ] specially when only primary coiling is employed as the main technique. [ 17 ] An increased use of diagnostic imaging revealing unruptured aneurysms as incidental findings may explain our results.…”

Comparison of outcomes between a ruptured and unruptured intracranial aneurysm: results from an Indonesian cohort study

“…Studies from the United States of America and Korea reported that the number of coiling performed for either unruptured or ruptured intracranial aneurysm has increased substantially, overtaking clipping as the most performed procedure for treating aneurysm. 16,17 Our study has several limitations. The retrospective and single-center designs have an inherent risk of confounding bias.…”

Surgical Clipping of Intracranial Aneurysms Using a Transcranial Neuroendoscopic Approach

“…There are two approaches for the treatment of intracranial aneurysm (IA), interventional therapy and surgical clipping, both of which have their advantages and disadvantages in terms of treatment efficacy. Many studies have shown that interventional therapy has fewer postoperative complications than craniotomies [2][3][4]. Unable to afford the high cost of interventional therapy, some patients choose to undergo craniotomy in China.…”