Abstract WMP30: Updates on the Paradigm Shift to Endovascular Modalities for Treatment of Ruptured and Unruptured Cerebral Aneurysms: National Inpatient Sample 2007-2016

Abstract

Introduction: The neuroendovascular space continues to evolve with innovative devices. In 2011, the Food and Drug Administration (FDA) approval of the Pipeline Embolization Device (PED) has led to adoption of flow diversion technique as the newest endovascular approach for cerebral aneurysm treatments. Methods: United States 2007-2016 National Inpatient Sample data was used to identify unruptured (UA) and ruptured aneurysms (RA) treated with open surgery and/or endovascular therapy. Trends in treatment patterns were analyzed. Results: A total of 39,282 hospital discharges were identified (UA: surgical n=7,847 vs. endovascular n=12,797; RA: surgical n=8,108 vs. endovascular n=10,530). For UA, similar mean numbers of cases were treated surgically & endovascularly up to 2011 (847.4 ± 107.7 vs. 1,120.4 ± 254.1, respectively, p=0.2118). From 2012, more UA were treated endovascularly than surgically (1,439.0 ± 419.2 vs. 722.0 ± 43.4, respectively, p=0.0007). Post 2011, the Northeast (NE), the Midwest (MW), and the South (S) performed significantly more endovascular therapies (NE: 153.8 ± 17.8 surgical vs. 290.0 ± 94.2 endovascular, p=0.0286; MW: 184.6 ± 15.1 surgical vs. 318.4 ± 81.6 endovascular, p=0.0331; S: 234.2 ± 7.2 surgical vs. 587.8 ± 152.5 endovascular, p<0.0001). For RA, similar mean numbers of cases were treated surgically & endovascularly up to 2011 (949.4 ± 52.8 vs. 1,054.4 ± 219.6, respectively, p=0.8481). From 2012, more RA were treated endovascularly than surgically (1,051.6 ± 330.2 vs. 672.2 ± 61.4, respectively, p=0.0183). The South treated significantly more RA endovascularly than surgically (418.8 ± 129.1 vs. 242.2 ± 10.9, respectively, p=0.0004). Conclusions: Treatment paradigm for cerebral aneurysms continues to shift towards endovascular options. The introduction of flow diversion technology in late 2011 may have contributed to the rise in endovascular treatments since then. The South displayed the greatest use of endovascular approaches.