Treatments for unruptured intracranial aneurysms

Pontes, Felipe Gomes de Barros; Vasconcelos, Vladimir; Baptista-Silva, Jose CC; Silva, Edina MK da

doi:10.1002/14651858.cd013312

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…The authors of the trial comparing coiling vs no intervention mention several factors for failure of this trial, including the difficulty to study withhold of a treatment instead of studying a new treatment, the need to include large numbers of patients and long follow-up, the huge costs in the absence of industry sponsoring, and the administrative hurdles. [7][8][9] Prediction modeling and decision analysis are currently the best evidence-based alternatives to accurately balance the risks and benefits of preventive treatment. For aneurysm rupture, risk scores have been developed to predict the absolute risk of aneurysm rupture based on easily retrievable patient and aneurysm characteristics.…”

Section: Classification Of Evidencementioning

confidence: 99%

Development of the SAFETEA Scores for Predicting Risks of Complications of Preventive Endovascular or Microneurosurgical Intracranial Aneurysm Occlusion

et al. 2022

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Objective:Preventive unruptured intracranial aneurysm occlusion can reduce the risk of subarachnoid hemorrhage, but both endovascular and microneurosurgical treatment carry a risk of serious complications. To improve individualized management decisions, we developed risk scores for complications of endovascular and microneurosurgical treatment based on easily retrievable patient, aneurysm, and treatment characteristics.Methods:For this multicenter cohort study, we combined individual patient data from unruptured intracranial aneurysm patients ≥18 years undergoing preventive endovascular treatment (standard, balloon-assisted or stent-assisted coiling, Woven EndoBridge-device, or flow-diverting stent) or microneurosurgical clipping at one of 10 participating centers from three continents between 2000-2018. The primary outcome was death from any cause or clinical deterioration from neurological complications ≤30 days. We selected predictors based on previous knowledge about relevant risk factors and predictor performance and studied the association between predictors and complications with logistic regression. We assessed model performance with calibration plots and concordance (c) statistics.Results:Of 1282 included patients, 94 (7.3%) had neurological symptoms that resolved <30 days, 140 (10.9%) had persisting neurological symptoms, and 6 died (0.5%)). At 30 days, 52 patients (4.1%) were dead or dependent. Predictors of procedural complications were: size of aneurysm, aneurysm location, familial subarachnoid hemorrhage, earlier atherosclerotic disease, treatment volume, endovascular modality (for endovascular treatment) or extra aneurysm configuration factors (for microneurosurgical treatment; branching artery from aneurysm neck or unfavorable dome-to-neck ratio), and age (acronym: SAFETEA). For endovascular treatment (n=752), the c-statistic was 0.72 (95%CI:0.67-0.77) and the absolute complication risk ranged from 3.2% (95%CI:1.6%-14.9%;≤1 point) to 33.1% (95%CI:25.4%-41.5%;≥6 points). For microneurosurgical treatment (n=530), the c-statistic was 0.72 (95%CI:0.67-0.77) and the complication risk ranged from 4.9% (95%CI:1.5%-14.9%;≤1 point) to 49.9% (95%CI:39.4%-60.6%;≥6 points).Conclusions:The SAFETEA risk scores for endovascular and microneurosurgical treatment are based on seven easily retrievable risk factors to predict the absolute risk of procedural complications in patients with unruptured intracranial aneurysms. The scores need external validation before the predicted risks can be properly used to support decision making in clinical practice.

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Section: Classification Of Evidencementioning

confidence: 99%

Development of the SAFETEA Scores for Predicting Risks of Complications of Preventive Endovascular or Microneurosurgical Intracranial Aneurysm Occlusion

et al. 2022

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“…E cient diagnosis and timely intervention for unruptured intracranial aneurysms (UIAs) yield favorable outcomes 1,2 . Exploration of this condition, focusing on screening, characteristics, risks, and management is of paramount signi cance in the eld of neurosurgery [3][4][5] . The 2015 American Heart Association (AHA) guidelines offer comprehensive recommendations for medical professionals in navigating this complex landscape 6 .…”

Section: Introductionmentioning

confidence: 99%

Comparing ChatGPT Responses with AHA Guidelines for Assessing Unruptured Intracranial Aneurysms: Establishment of a Simple Rating System

Chang,

Lee,

Huang

et al. 2024

Preprint

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Introduction Efficient diagnosis and intervention for unruptured intracranial aneurysms (UIAs) are crucial for favorable outcomes. Our study aimed to evaluate the accuracy and alignment of Chat Generative Pre-trained Transformer (ChatGPT) with established medical standards by systematically evaluating its responses using the American Heart Association (AHA) guidelines for the management of UIAs as a reference. This initiative bridges advanced artificial intelligence (AI) technology and medical practice norms, and contributes to the discussion on the role of AI in the dissemination of medical information. Methods In our collaborative study, we systematically assessed ChatGPT 3.5's responses by posing clinical questions aligned with AHA guidelines and evaluating them on a 1 to 5 scale for agreement and comprehensiveness. This method allowed us to objectively gauge ChatGPT's alignment with AHA medical guidelines. Results We introduced a set of ten clinical questions related to UIAs. Within this set, ChatGPT's responses achieved a 5-point rating for four questions. A further four questions were rated 3 points, and the remaining two questions received a score of 2. Conclusions By establishing a scoring system, we assessed the accuracy of ChatGPT responses to questions related to UIAs. It provides excellent results for screening, risk factors, and as a diagnostic tool. However, there is room for improvement in terms of the rupture risk and management.

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