Trends in Unruptured Intracranial Aneurysm Treatment: Findings from New York Statewide Administrative Data, 2019-2023.

Abstract

Prior population-based analyses (2005-7) reported increasing utilization of endovascular repair for unruptured intracranial aneurysms (UIAs), but with stagnant outcomes. Whether this relationship persists in the modern era remains unknown. The New York Statewide Planning and Research Cooperative System database was queried for patients discharged between 2019 and 2023 with primary diagnosis of UIA. Procedure modality (open vs endovascular) was identified using International Classification of Diseases-10-PCS codes. Primary outcomes were discharge-to-home and length of stay (LOS). The top ten hospitals by procedural volume were considered "high-volume," with remaining hospitals considered "lower-volume". Multivariable negative binomial and logistic regression models were constructed by modality. Overall discharge-to-home rates improved for both open (72% to 90%) and endovascular (88% to 96%) treatment since 2005-7. Mean LOS decreased for both open (7 to 5 days) and endovascular procedures (4 to 2 days) with shorter median LOS at high-volume centers among open elective cases. The population-adjusted rate (PAR) of UIA treatment increased more than two-fold from 3.45 to 7.34 per 100,000 persons. Endovascular PAR increased three-fold from 1.98 to 6.15 per 100,000 with 84% of all cases undergoing endovascular repair. While open repair declined markedly to 16%, PAR remained more stable (1.47 to 1.19). The proportion of endovascular procedures performed at high-volume centers declined significantly from 84% to 64%, whereas open surgery remained centralized (77% to 82%). Despite the massive increase in endovascular cases, with expected improvements, we demonstrate marked improvements for open surgery across both outcomes. In fact, microsurgical clipping, in terms of discharge-to-home and LOS, now rival historical endovascular results.