RT Journal Article
SR Electronic
T1 Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1437
OP 1444
DO 10.3174/ajnr.A7648
VO 43
IS 10
A1 W. Boisseau
A1 T.E. Darsaut
A1 R. Fahed
A1 J.M. Findlay
A1 R. Bourcier
A1 G. Charbonnier
A1 S. Smajda
A1 J. Ognard
A1 D. Roy
A1 F. Gariel
A1 A.P. Carlson
A1 E. Shotar
A1 G. Ciccio
A1 G. Marnat
A1 P.B. Sporns
A1 T. Gaberel
A1 V. Jecko
A1 A. Weill
A1 A. Biondi
A1 G. Boulouis
A1 A.L. Bras
A1 S. Aldea
A1 T. Passeri
A1 S. Boissonneau
A1 N. Bougaci
A1 J.C. Gentric
A1 J.D.B. Diestro
A1 A.T. Omar
A1 H.M. Al-Jehani
A1 G. El Hage
A1 D. Volders
A1 Z. Kaderali
A1 I. Tsogkas
A1 E. Magro
A1 Q. Holay
A1 J. Zehr
A1 D. Iancu
A1 J. Raymond
YR 2022
UL http://www.ajnr.org/content/43/10/1437.abstract
AB 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 κ 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 (κ = 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.ISFDintrasaccular flow disruptorsRCTrandomized controlled trial