Abstract
The outcome of treatment for unruptured intracranial aneurysm by surgery or endovascular therapy appeared to be related to the volume of patients treated by the hospital. We performed an analysis in the ATENA series to determine whether the outcome of endovascular treatment was different in hospitals with low and high volumes of cases. The ATENA series included 649 patients with 739 unruptured intracranial aneurysms. Patients were classified into 2 groups. Group A had 171 patients with 197 aneurysms in 13 centers that treated < or =20 patients; group B, 478 patients with 542 aneurysms in 14 centers that treated > or =21 patients. Groups A and B had similar patient populations and aneurysm characteristics. Stent placement was used in group B more frequently than in group A (9.6% versus 2.5%, P = .0016). The global rate of adverse events was not significantly different in groups A and B (16.0% and 14.4%, respectively). Thromboembolic events and intraoperative rupture were not significantly more frequent in group A than in group B. One-month mortality and morbidity rates were not significantly different in groups A (2.3% and 1.8%, respectively) and B (1.0% and 1.7%, respectively). Anatomic outcomes for groups A and B were not significantly different. Clinical and anatomic outcomes of endovascular treatments for unruptured intracranial aneurysms were similar in hospitals with low and high volumes of cases.
Highlights
AND PURPOSE: The outcome of treatment for unruptured intracranial aneurysm by surgery or endovascular therapy appeared to be related to the volume of patients treated by the hospital
Our analysis demonstrated that at least in France, clinical and anatomic outcomes of endovascular treatments for unruptured intracranial aneurysms are similar in centers with low and high volumes of cases/hospital
This is probably related to the fact that most neurointerventional teams participating in ATENA have had long intensive experience with the endovascular treatment of intracranial aneurysms
Summary
The ATENA series included 649 patients with 739 unruptured intracranial aneurysms. Group A had 171 patients with 197 aneurysms in 13 centers that treated Յ20 patients; group B, 478 patients with 542 aneurysms in 14 centers that treated Ն21 patients. Protocol The ATENA protocol has been previously presented.[1] Briefly, ATENA was conducted by the French Society of Neuroradiology to evaluate the results of endovascular treatment for patients with UIAs. From June 2005 to October 2006, 649 patients were prospectively and consecutively enrolled from 27 Canadian and French neurointerventional centers to be treated with an endovascular approach. The inclusion criteria were the presence of Ն1 unruptured previously untreated intracranial aneurysm of Ͻ15 mm. Patients with fusiform and dissecting aneurysms and aneurysms associated with brain arteriovenous malformations were excluded. The protocol was approved by the Ethics Committee of Reims, and informed consent was obtained from all patients
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