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Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study.
Boisseau, W; Darsaut, T E; Fahed, R; Findlay, J M; Bourcier, R; Charbonnier, G; Smajda, S; Ognard, J; Roy, D; Gariel, F; Carlson, A P; Shotar, E; Ciccio, G; Marnat, G; Sporns, P B; Gaberel, T; Jecko, V; Weill, A; Biondi, A; Boulouis, G; Bras, A L; Aldea, S; Passeri, T; Boissonneau, S; Bougaci, N; Gentric, J C; Diestro, J D B; Omar, A T; Al-Jehani, H M; Hage, G El; Volders, D; Kaderali, Z; Tsogkas, I; Magro, E; Holay, Q; Zehr, J; Iancu, D; Raymond, J.
Afiliação
  • Boisseau W; From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
  • 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.
  • Fahed R; Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
  • 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.
  • Bourcier R; Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France.
  • Charbonnier G; Departments of Interventional Neuroradiology (G. Charbonnier, A.B.).
  • Smajda S; Departments of Interventional Neuroradiology (S.S.).
  • Ognard J; Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France.
  • Roy D; From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
  • Gariel F; Departments of Neuroradiology (F.G., G.M.).
  • Carlson AP; Department of Neurosurgery (A.P.C.), University of New Mexico Hospital, Albuquerque, New Mexico.
  • Shotar E; Department of Neuroradiology (E.S.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France.
  • Ciccio G; Department of Interventional Neuroradiology (G. Ciccio), Centre Hospitalier de Bastia, Bastia, Corse, France.
  • Marnat G; Departments of Neuroradiology (F.G., G.M.).
  • Sporns PB; Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
  • Gaberel T; Department of Diagnostic and Interventional Neuroradiology (P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Jecko V; Department of Neurosurgery (T.G.), University Hospital of Caen, Caen, France.
  • Weill A; Neurosurgery (V.J.), University Hospital of Bordeaux, Bordeaux, France.
  • Biondi A; From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology.
  • Boulouis G; Departments of Interventional Neuroradiology (G. Charbonnier, A.B.).
  • Bras AL; Department of Neuroradiology (G.B.), University Hospital of Tours, Tours, Indre et Loire, France.
  • Aldea S; Department of Radiology (A.L.B.), Groupement Hospitaliser Bretagne Atlantique-Hôpital Chubert, Vannes, Bretagne, France.
  • Passeri T; Neurosurgery (S.A.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
  • Boissonneau S; Department of Neurosurgery (T.P.), Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France.
  • Bougaci N; Department of Neurosurgery (S.B.), La Timone Hospital.
  • Gentric JC; L'Institut National de la Santé et de la Recherche Médicale (S.B.), Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France.
  • Diestro JDB; Neurosurgery (N.B.), Besançon University Hospital, Besançon, France.
  • Omar AT; Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France.
  • Al-Jehani HM; Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Hage GE; Division of Neurosurgery (A.T.O.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Volders D; 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.
  • Kaderali Z; Department of Neurosurgery (G.E.H.), Centre Hospitalier de l'Université de Montréal,Montreal, Québec, Canada.
  • Tsogkas I; Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada.
  • Magro E; Division of Neurosurgery (Z.K.), GB1-Health Sciences Centre, Winnipeg, Manitoba, Canada.
  • Holay Q; Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
  • Zehr J; 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.
  • Iancu D; Department of Radiology (Q.H.), Hôpital d'Instruction des Armées Saint-Anne, Toulon, France.
  • Raymond J; Department of Mathematics and Statistics (J.Z.), Pavillon André-Aisenstadt,Montreal, Québec, Canada.
AJNR Am J Neuroradiol ; 43(10): 1437-1444, 2022 10.
Article em En | MEDLINE | ID: mdl-36137654
ABSTRACT
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article