Neurointervention.  2020 Mar;15(1):18-24. 10.5469/neuroint.2019.00157.

Endovascular Treatment for Intracranial Aneurysms: A Nationwide Survey in Korea

• Kim JJ
• Cho KC
• Jung WS
• Suh SH

• KMID: 2502078
• DOI: http://doi.org/10.5469/neuroint.2019.00157

Abstract

Purpose
In Korea, endovascular treatment (EVT) for intracranial aneurysms (IAs) has increased steadily. We conducted a nationwide survey to evaluate the current status of EVT for IAs and to identify treatment preference in the real world.
Materials and Methods
A Google online survey was distributed to representative clinicians at hospitals treating IAs, where members of Korean Society of Interventional Neuroradiology (KSIN). The data was collected from October 2017 to December 2017. The responding hospitals were divided into 2 groups (tertiary and non-tertiary hospitals). And variable factors involved in decision making for treatment were evaluated.
Results
In total, 73 hospitals (tertiary: 37, non-tertiary: 36) responded to the survey. Most hospitals that responded had over 100 cases of diagnostic angiography (93%) and over 50 cases of EVT for IAs (74%) performed in 2016. The proportion of EVT for ruptured aneurysms in non-tertiary hospitals was significantly higher than tertiary hospitals (49% vs. 9%). The proportion of EVT for unruptured aneurysms at non-tertiary hospitals was significantly higher than tertiary hospitals (66% vs. 44%). Most physicians tended to make decision for treatment on location, shape, and size of unruptured IAs and patients’ age, more than the results from previous clinical trials for unruptured IAs. Although EVT was preferred for older patients (age >70) with unruptured IAs (99%), surgical clipping was still considered as the first treatment of choice for younger patients (age 30 to 50 years) at considerable rates (56%). Over two-thirds of respondents preferred surgical clipping for middle cerebral artery aneurysms, while EVT was preferred initially at other locations.
Conclusion
This nationwide survey showed that EVT is considered as the first treatment modality for IAs and there is a discrepancy between current guidelines and real-world practice for decision making of treatment options.

Keyword

Aneurys; Treatment; Surveys; Hospitals; Korea

Figure

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  Fig. 1. The number of specialists who work as interventionists in tertiary and non-tertiary hospitals.

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  Fig. 2. EVT of IAs in 2016 according to the type of hospital. EVT, endovascular treatment; IAs, intracranial aneurysms.

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