Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study

被引：7

作者：

Boisseau, W. ^{[1
]}

Darsaut, T. E. ^{[4
]}

Fahed, R. ^{[5
,6
]}

Findlay, J. M. ^{[4
]}

Bourcier, R. ^{[7
]}

Charbonnier, G. ^{[8
]}

Smajda, S. ^{[10
]}

Ognard, J. ^{[12
]}

Roy, D. ^{[1
]}

Gariel, F. ^{[13
]}

Carlson, A. P. ^{[15
]}

Shotar, E. ^{[16
]}

Ciccio, G. ^{[17
]}

Marnat, G. ^{[13
]}

Sporns, P. B. ^{[18
,19
]}

Gaberel, T. ^{[20
]}

Jecko, V. ^{[14
]}

Weill, A. ^{[1
]}

Biondi, A. ^{[8
]}

Boulouis, G. ^{[21
]}

Bras, A. L. ^{[22
]}

Aldea, S. ^{[11
]}

Passeri, T. ^{[23
]}

Boissonneau, S. ^{[24
,25
]}

Bougaci, N. ^{[9
]}

Gentric, J. C. ^{[12
]}

Diestro, J. D. B. ^{[26
]}

Omar, A. T. ^{[27
]}

Al-Jehani, H. M. ^{[28
]}

El Hage, G. ^{[2
,3
]}

Volders, D. ^{[29
]}

Kaderali, Z. ^{[30
]}

Tsogkas, I. ^{[18
]}

Magro, E. ^{[31
]}

Holay, Q.

Zehr, J.

Iancu, D. ^{[1
]}

Raymond, J. ^{[1
]}

机构：

[1] CHU Montreal, Dept Radiol, Montreal, PQ, Canada

[2] CHU Montreal, Div Neuroradiol, Montreal, PQ, Canada

[3] Ctr Hospitalier Univ Montreal, Dept Neurosurg, Montreal, PQ, Canada

[4] Univ Alberta Hosp, Mackenzie Hlth Sci Ctr, Dept Surg, Div Neurosurg, Edmonton, AB, Canada

[5] Ottawa Hosp, Ottawa Hosp Res Inst, Dept Med, Div Neurol, Ottawa, ON, Canada

[6] Univ Ottawa, Ottawa, ON, Canada

[7] Univ Hosp Nantes, Dept Neuroradiol, Nantes, France

[8] Besancon Univ Hosp, Dept Intervent Neuroradiol, Besancon, France

[9] Besancon Univ Hosp, Dept Neurosurg, Besancon, France

[10] Fdn Ophtalmol Adolphe Rothschild, Dept Intervent Neuroradiol, Paris, France

[11] Fdn Ophtalmol Adolphe Rothschild, Dept Neurosurg, Montreal, PQ, Canada

[12] Hop Cavale Blanche, Dept Intervent Neuroradiol, Room D03 5462b, Montreal, PQ H2X 0C1, France

[13] Univ Hosp Bordeaux, Dept Neuroradiol, Bordeaux, France

[14] Univ Hosp Bordeaux, Dept Neurosurg, Bordeaux, France

[15] Univ New Mexico Hosp, Dept Neurosurg, Albuquerque, NM USA

[16] Grp Hosp Pitie Salpetriere, Dept Neuroradiol, Paris, France

[17] Ctr Hosp Bastia, Dept Intervent Neuroradiol, Bastia, Corse, France

[18] Univ Hosp Basel, Dept Neuroradiol Clin Radiol & Nucl Med, Basel, Switzerland

[19] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[20] Univ Hosp Caen, Dept Neurosurg, Caen, France

[21] Univ Hosp Tours, Dept Neuroradiol, Tours, Indre et Loire, France

[22] Groupement Hospitaliser Bretagne Atlantique Hop Ch, Dept Radiol, Vannes, Bretagne, France

[23] Univ Paris, AP HP, Lariboisiere Hosp, Dept Neurosurg, Paris, France

[24] Aix Marseille Univ, Timone Hosp, Inst Neurosci Syst, Dept Neurosurg, Marseille, France

[25] Aix Marseille Univ, Inst Natl St & Rech Med, Inst Neurosci Syst, Marseille, France

[26] Univ Toronto, St Michaels Hosp, Dept Med Imaging, Div Diagnost & Therapeut Neuroradiol, Toronto, ON, Canada

[27] Univ Toronto, St Michaels Hosp, Dept Surg, Div Neurosurg, Toronto, ON, Canada

[28] Imam Abdulrahman bin Faisal Univ, King Fahad Hosp Univ, Dept Neurosurg Radiol & Crit Care Med, Al Khobar, Saudi Arabia

[29] Dalhousie Univ, Dept Radiol, Halifax, NS, Canada

[30] GB1 Hlth Sci Ctr, Div Neurosurg, Winnipeg, MB, Canada

[31] CHU Cavale Blanche, UBO Inst Natl St & Rech Med, Dept Neurosurg, LaTIM,UMR1101, Brest, France

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2022年 / 43卷 / 10期

关键词：

CEREBRAL-ARTERY ANEURYSMS; RUPTURED INTRACRANIAL ANEURYSMS; RANDOMIZED CARE TRIAL; FLOW DIVERSION; MANAGEMENT; COILING; DESIGN; ISAT;

D O I：

10.3174/ajnr.A7648

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND PURPOSE: MCA aneurysms are still commonly clipped surgically despite the recent development of a number of endovascular tools and techniques. We measured clinical uncertainty by studying the reliability of decisions made for patients with middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS: A portfolio of 60 MCA aneurysms was presented to surgical and endovascular specialists who were asked whether they considered surgery or endovascular treatment to be an option, whether they would consider recruitment of the patient in a randomized trial, and whether they would provide their final management recommendation. Agreement was studied using ? statistics. Intrarater reliability was assessed with the same, permuted portfolio of cases of MCA aneurysm sent to the same specialists 1 month later. RESULTS: Surgical management was the preferred option for neurosurgeons (n = 844/1320; [64%] responses/22 raters), while endovascular treatment was more commonly chosen by interventional neuroradiologists (1149/1500 [76.6%] responses/25 raters). Interrater agreement was only "slight " for all cases and all judges (kappa = 0.094; 95% CI, 0.068?0.130). Agreement was no better within specialties or with more experience. On delayed requestioning, 11 of 35 raters (31%) disagreed with themselves on at least 20% of cases. Surgical management and endovascular treatment were always judged to be a treatment option, for all patients. Trial participation was offered to patients 65% of the time. CONCLUSIONS: Individual clinicians did not agree regarding the best management of patients with MCA aneurysms. A randomized trial comparing endovascular with surgical management of patients with MCA aneurysms is in order.

引用

页码：1437 / 1444

页数：8

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