Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study.

Humans Clinical Decision-Making Reproducibility of Results Uncertainty Intracranial Aneurysm / diagnostic imaging Neurosurgical Procedures / methods Embolization, Therapeutic Endovascular Procedures Treatment Outcome Retrospective Studies

Journal

AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708

Informations de publication

Date de publication:
10 2022
Historique:
received: 30 03 2022
accepted: 28 06 2022
pubmed: 23 9 2022
medline: 30 12 2022
entrez: 22 9 2022
Statut: ppublish

Résumé

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. 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. Surgical management was the preferred option for neurosurgeons ( 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.

Sections du résumé

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 (
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.

Identifiants

DOI: 10.3174/ajnr.A7648 PMID: 36137654 PMC: PMC9575541
pubmed: 36137654
pii: ajnr.A7648
doi: 10.3174/ajnr.A7648
pmc: PMC9575541
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1437-1444

Commentaires et corrections

Type : ErratumIn

Informations de copyright

© 2022 by American Journal of Neuroradiology.

Auteurs

W Boisseau (W)

From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
ORCID: 0000-0001-8120-5128

T E Darsaut (TE)

Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada.
ORCID: 0000-0003-4662-1550

R Fahed (R)

Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
ORCID: 0000-0002-1887-5097

J M Findlay (JM)

Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada.
ORCID: 0000-0002-4842-3905

R Bourcier (R)

Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France.
ORCID: 0000-0002-6506-4019

G Charbonnier (G)

Departments of Interventional Neuroradiology (G. Charbonnier, A.B.).
ORCID: 0000-0002-4425-3849

S Smajda (S)

Departments of Interventional Neuroradiology (S.S.).
ORCID: 0000-0002-6486-1710

J Ognard (J)

Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France.
ORCID: 0000-0003-4495-7464

D Roy (D)

From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
ORCID: 0000-0002-6066-4453

F Gariel (F)

Departments of Neuroradiology (F.G., G.M.).
ORCID: 0000-0003-4636-2034

A P Carlson (AP)

Department of Neurosurgery (A.P.C.), University of New Mexico Hospital, Albuquerque, New Mexico.
ORCID: 0000-0003-2189-3699

E Shotar (E)

Department of Neuroradiology (E.S.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France.
ORCID: 0000-0002-8712-8431

G Ciccio (G)

Department of Interventional Neuroradiology (G. Ciccio), Centre Hospitalier de Bastia, Bastia, Corse, France.
ORCID: 0000-0001-5801-0816

G Marnat (G)

Departments of Neuroradiology (F.G., G.M.).
ORCID: 0000-0002-7611-7753

P B Sporns (PB)

Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Department of Diagnostic and Interventional Neuroradiology (P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
ORCID: 0000-0002-3028-0539

T Gaberel (T)

Department of Neurosurgery (T.G.), University Hospital of Caen, Caen, France.
ORCID: 0000-0003-0111-0626

V Jecko (V)

Neurosurgery (V.J.), University Hospital of Bordeaux, Bordeaux, France.
ORCID: 0000-0002-4811-490X

A Weill (A)

From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
ORCID: 0000-0002-0281-6201

A Biondi (A)

Departments of Interventional Neuroradiology (G. Charbonnier, A.B.).
ORCID: 0000-0002-3185-0740

G Boulouis (G)

Department of Neuroradiology (G.B.), University Hospital of Tours, Tours, Indre et Loire, France.
ORCID: 0000-0001-8422-9205

A L Bras (AL)

Department of Radiology (A.L.B.), Groupement Hospitaliser Bretagne Atlantique-Hôpital Chubert, Vannes, Bretagne, France.
ORCID: 0000-0001-5691-3894

S Aldea (S)

Neurosurgery (S.A.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
ORCID: 0000-0003-4177-147X

T Passeri (T)

Department of Neurosurgery (T.P.), Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France.
ORCID: 0000-0003-4759-0389

S Boissonneau (S)

Department of Neurosurgery (S.B.), La Timone Hospital.
L'Institut National de la Santé et de la Recherche Médicale (S.B.), Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France.
ORCID: 0000-0002-7503-6628

N Bougaci (N)

Neurosurgery (N.B.), Besançon University Hospital, Besançon, France.
ORCID: 0000-0001-6511-9342

J C Gentric (JC)

Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France.
ORCID: 0000-0002-1655-1371

J D B Diestro (JDB)

Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0001-8450-2021

A T Omar (AT)

Division of Neurosurgery (A.T.O.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0002-2965-8506

H M Al-Jehani (HM)

Department of Neurosurgery, Radiology and Critical Care Medicine (H.M.A.-J.), King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia.
ORCID: 0000-0002-3830-9789

G El Hage (GE)

Department of Neurosurgery (G.E.H.), Centre Hospitalier de l'Université de Montréal,Montreal, Québec, Canada.
ORCID: 0000-0002-7548-093X

D Volders (D)

Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada.
ORCID: 0000-0003-4074-8702

Z Kaderali (Z)

Division of Neurosurgery (Z.K.), GB1-Health Sciences Centre, Winnipeg, Manitoba, Canada.
ORCID: 0000-0002-2866-7160

I Tsogkas (I)

Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
ORCID: 0000-0003-2561-9603

E Magro (E)

Department of Neurosurgery (E.M.), Centre Hospitalier Universitaire Cavale Blanche, UBO L'Institut National de la Santé et de la Recherche Médicale, LaTIM UMR 1101, Brest, France.
ORCID: 0000-0003-1319-5292

Q Holay (Q)

Department of Radiology (Q.H.), Hôpital d'Instruction des Armées Saint-Anne, Toulon, France.
ORCID: 0000-0002-3781-4628

J Zehr (J)

Department of Mathematics and Statistics (J.Z.), Pavillon André-Aisenstadt,Montreal, Québec, Canada.
ORCID: 0000-0002-8295-4590

D Iancu (D)

From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
ORCID: 0000-0003-2041-9178

J Raymond (J)

From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology jean.raymond@umontreal.ca.
ORCID: 0000-0003-1978-4274

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Diagnostic › Prise de décision clinique › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Reproductibilité des résultats › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Incertitude › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Artériopathies intracrâniennes › Anévrysme intracrânien › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Thérapeutique › Occlusion thérapeutique › Embolisation thérapeutique › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Surgical or Endovascular Treatment of MCA...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Surgical or Endovascular Treatment of MCA...