J Korean Med Sci.  2020 Oct;35(39):e323. 10.3346/jkms.2020.35.e323.

National Trends in the Treatment of Ruptured Cerebral Aneurysms in Korea Using an Age-adjusted Method

• Park HR
• Kim JH
• Park S
• Chang JC
• Park SQ

• KMID: 2507606
• DOI: http://doi.org/10.3346/jkms.2020.35.e323

Abstract

Background
Two primary treatment methods are used for ruptured cerebral aneurysms, surgical clipping and endovascular coiling. In recent decades, endovascular coiling has shown remarkable progress compared to surgical clipping, along with technological developments. The aim of this study was to investigate the recent trends in treatments for ruptured cerebral aneurysms in Korea.
Methods
The data were obtained from the National Health Insurance database. We evaluated the trends in endovascular coiling and surgical clipping for ruptured aneurysms for the period 2000–2017. We obtained the number of prescriptions with International Classification of Diseases, 9th Revision, clinical modification codes related to nontraumatic subarachnoid hemorrhage and prescription codes S4641/4642 for surgical clipping and M1661/1662 for endovascular coiling. The medical expenses for each prescription were also obtained. The primary outcomes included the cumulative number of patients, patient rates per 100,000 people, and the correlation between patient rates and the percentage of the population in each age group.
Results
In the case of surgical clipping, there were no increasing or decreasing trends in the cumulative number of patients when the population/age group was ignored. When examining the trends in patient rates per 100,000 population at each year in male, there was no increasing or decreasing trend in the number of surgical clippings between the age groups, in spite of a decreasing tendency in the number of surgical clipping in male in their 40s and older than 60. In females, the surgical clipping rates tended to decrease only in patients older than 60 years, but there was no tendency to increase or decrease in the other ages. In contrast, the cumulative number of patients who underwent endovascular coiling for ruptured cerebral aneurysms increased year by year regardless of the population/age group. In both male and female, there was no increasing or decreasing trend only in the group aged 40 or younger and there was an increasing tendency in the rest of the age groups. In the trend of medical expenses, both the cost of surgical clipping and endovascular coiling showed increases. Specifically, the medical expense trend in endovascular coiling increased more rapidly than that for surgical clipping.
Conclusion
There was a significant increase in the proportion of patients with ruptured aneurysms undergoing endovascular coiling between 2010 and 2017, whereas the use of surgical clipping decreased. The endovascular coiling was significantly increased in all age groups and surgical clipping was decreased in all age groups, especially in patients under 50 years of age.

Keyword

Cerebral Aneurysm; Subarachnoid Hemorrhage; Endovascular Technique; Microsurgical Clipping

Figure

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  Fig. 1 Overall trends of the coiling and clipping procedures in male and female patients. (A) Overall trends of the coiling procedures in male patients. The cumulative number of patients regardless of the population or age group showed an increase over the study period. The patient rate per 100,000 population showed an increase in all age groups, except in patients less than 40 years old. (B) Overall trends of the coiling procedures in female patients. The cumulative number of patients regardless of the population or age group showed an increase. The patient rate per 100,000 population showed an increase in all age groups, except for in patients younger than 40 years, which showed a steady trend. (C) Overall trends of the clipping procedures in male patients. There was no increasing or decreasing trend in the cumulative number of patients over the study period. The patient rates also show trends toward decreases or no change. The patient rates by year showed decreases in all age groups. (D) Overall trends of the clipping procedures in female patients. The cumulative number of patients and the patient rates showed decreases or no change.

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  Fig. 2 Analysis of the patient rates and the percentage of the population by year according to each age group. (A) Male patients treated by coiling procedure. There was a negative correlation in the under 40 and 40s age groups and a positive correlation in the 50s and over 60-year-old age groups with statistical significance in all age groups. (B) Female patients treated by coiling procedure. There was a negative correlation in the under 40 and 40s age groups and a positive correlation in the 50s and over 60 age groups with statistical significance in all age groups. (C) Male patients treated by clipping procedure. There was a positive correlation in patients under 40 and in the 40s age group and a negative correlation in the 50s and over 60 years age groups. It was statistically significant in the under 40 and 40s age groups. (D) Female patients treated by clipping procedure. There was a positive correlation in the under 40 and 40s age groups and a negative correlation in the 50s and over 60 years old groups. It was statistically significant in the under 40 and 40s age groups.

• 

  Fig. 3 Overall trend of medical expenses for endovascular coiling and surgical clipping.

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