Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry

NVQI-QOD Registry Investigators

doi:10.1227/neu.0000000000003283

Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry

NVQI-QOD Registry Investigators

Radiology

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge. RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days). CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.

Original language	English (US)
Article number	10.1227/neu.0000000000003283
Journal	Neurosurgery
DOIs	https://doi.org/10.1227/neu.0000000000003283
State	Accepted/In press - 2024

Funding

This research was supported by the SNIS, AANS/NeuroPoint Alliance (NPA), and AANS/Congress of Neurological Surgeons (CNS) Cerebrovascular Section, through the NVQI-QOD Registry. The NVQI-QOD Registry is a collaboration between the SNIS and the AANS/NPA through the use of a PSO. The registry plays a key role in helping to identify best practices and demonstrating a hospital's dedication to improving patient care. The SNIS and AANS/CNS Cerebrovascular Section aim to advance neurovascular patient care through education, research, and advocacy. The following collaborators were involved in data collection as registry site principal investigators. NVQI-QOD Cerebral Aneurysm Registry Contributors: Ali Alaraj, Dorothea Altschul, John Baker, Andrew Bauer, Andrew Carlson, Vivek Deshmukh, Justin Fraser, Michael Hall, Ricardo Hanel, Mark Harrigan, Shazam Hussain, Paul Jacobson, Manesh Jayaraman, Mary Jensen, Matthew Lawson, Alex Linn, Stephen Monteith, Sanjay Patra, Todd Peebles, Eric Peterson, Nima Ramezan, John Reavey-Cantwell, Matthew Reynolds, Jeff Saver, Clemens Schirmer, Mitesh Shah, Harish Shownkeen, Adnan Siddiqui, Jeffrey Thomas, Babu Welch. Author Contributions: Varun Padmanaban: conceptualization, methodology, formal analysis, data curation, writing\u2014original draft; Thaddeus Harbaugh: formal analysis, data curation, writing\u2014original draft; Junjia Zhu: software, formal analysis, data curation; Shouhao Zhou: software, formal analysis, data curation; Sameer Ansari: methodology, supervision, project administration, funding acquisition; Jay Howington: methodology, supervision, project administration, funding acquisition; Daniel Sahlein: methodology, supervision, project administration, funding acquisition; Juan Tejada: methodology, supervision, project administration, funding acquisition; D. Andrew Wilkinson: methodology, writing\u2014review & editing; Scott Simon: methodology, writing\u2014review & editing; Kevin Cockroft: conceptualization, methodology, resources, writing\u2014review & editing, funding acquisition; Ephraim Church: conceptualization, methodology, resources, writing\u2014review & editing; supervision, project administration, funding acquisition.

Keywords

Middle cerebral artery aneurysms
Small cerebral aneurysms
Subarachnoid hemorrhage
Surgical complications
Unruptured cerebral aneurysm

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1227/neu.0000000000003283

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@article{3be67ec666c9461aae83f75bd4ec2249,

title = "Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry",

abstract = "BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge. RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days). CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.",

keywords = "Middle cerebral artery aneurysms, Small cerebral aneurysms, Subarachnoid hemorrhage, Surgical complications, Unruptured cerebral aneurysm",

author = "{NVQI-QOD Registry Investigators} and Varun Padmanaban and Thaddeus Harbaugh and Junjia Zhu and Shouhao Zhou and Ansari, {Sameer A.} and Howington, {Jay U.} and Sahlein, {Daniel H.} and Tejada, {Juan G.} and {Andrew Wilkinson}, D. and Simon, {Scott D.} and Cockroft, {Kevin M.} and Church, {Ephraim W.}",

year = "2024",

doi = "10.1227/neu.0000000000003283",

language = "English (US)",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment

T2 - An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry

AU - NVQI-QOD Registry Investigators

AU - Padmanaban, Varun

AU - Harbaugh, Thaddeus

AU - Zhu, Junjia

AU - Zhou, Shouhao

AU - Ansari, Sameer A.

AU - Howington, Jay U.

AU - Sahlein, Daniel H.

AU - Tejada, Juan G.

AU - Andrew Wilkinson, D.

AU - Simon, Scott D.

AU - Cockroft, Kevin M.

AU - Church, Ephraim W.

PY - 2024

Y1 - 2024

N2 - BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge. RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days). CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.

AB - BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge. RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days). CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.

KW - Middle cerebral artery aneurysms

KW - Small cerebral aneurysms

KW - Subarachnoid hemorrhage

KW - Surgical complications

KW - Unruptured cerebral aneurysm

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JO - Neurosurgery

JF - Neurosurgery

M1 - 10.1227/neu.0000000000003283

ER -

Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry

Abstract

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