Abstract WP20: Patterns Of Alert And Management Of Cerebral Aneurysms Using An Incidental Aneurysm Alert System

Abstract

Introduction: Incidentally discovered cerebral aneurysms are increasingly common as patients are more frequently imaged. To aid in this management, we developed an aneurysm alert system. Here we describe the effectiveness and outcomes of our Incidental Aneurysm Alert System (IAAS). Methods: IAAS received MRA and CTA reports from our Radiology department. Reports were parsed using natural language processing to identify ‘aneurysm’, automatically generating alerts for the interventional neuroradiologists. Background demographics, referral patterns, risk factors and management were then assessed. Results: From March to December 2020, 145 consecutive reports were reviewed. A 87% cerebral aneurysm detection accuracy rate resulted after excluding duplicates and non-vascular lesions, resulting in 117 unique cases. Median age was 65 and 65% were female. Most frequent races were 53% non-Hispanic White, 19% other, 9% Asian, 6% Black; 26% were of Hispanic ethnicity. The most common indication was acute stroke (29%). Of the detected aneurysms, 49% resulted in consultation with an interventionalist. Neurology was the most common referring specialty (37%). Of those referred, 49% underwent diagnostic and/or therapeutic angiography. Sixty eight percent who underwent cerebral angiography were intervened upon immediately or within 2 years of discovery. Seven percent were ruptured on discovery. Aneurysms were most frequently treated with flow diversion (37%), coiling (37%), and clipping (16%).Mean PHASES score of referred patients was 4.3, conferring 0.9-1.3% 5-year rupture risk. Asians and Hispanics had higher PHASES scores on presentation of 6.1 (1.7% 5-year rupture risk) and 5.2 (1.3% 5-year rupture risk) respectively, compared to Non-Hispanic Caucasians of 3.8 (0.9% 5-year rupture risk). For Hispanics, mean age was 55 and mean aneurysm size 9.8 mm as compared to 66 and 5.6 mm in non-Hispanic Caucasians. There were no significant differences in aneurysm risk factors. Conclusions: IAAS is an effective alerting system. Hispanics were younger with larger aneurysms on detection. IAAS may have potential value in connecting general physicians with cerebrovascular specialists, improving the management of incidentally discovered cerebral aneurysms.