Article Figures & Data
Figures
- Fig 1.
Example. One of the 35 cases, corresponding vignette, and survey questions that were presented to judges is illustrated.
- Fig 2.
Responses to question 4 (best final management choice). FD was commonly selected as the best final treatment choice for anterior circulation (A, 9-mm asymptomatic paraophthalmic aneurysm; 10 votes for FD) or sidewall aneurysms (B, 38-mm asymptomatic sidewall basilar trunk aneurysm; 12 votes for FD).
- Fig 3.
Responses to question 1 (Is flow diversion an option?). FD was considered an option by at least 7 judges in all cases. The cases in which flow diversion was most frequently judged not to be a viable option were a 20-mm MCA bifurcation aneurysm (A, 15/22 “no” votes) and a 38-mm basilar tip aneurysm (B, 14/22 “no” votes). The cases in which flow diversion was least frequently thought not to be an option, with only 1/22 “no” votes each, were a 22-mm ophthalmic segment aneurysm (C) and a recurrent previously coiled carotid bifurcation aneurysm (D).
- Fig 4.
Responses to question 2 (Any other treatment option?). In all cases, judges were able to find a viable alternative to flow diversion. The cases with the largest number of votes for “No, flow diversion only” were a ruptured supraclinoid carotid blister aneurysm (A, 5 votes) and a giant basilar aneurysm with an associated AVM (B, 4 votes). All other aneurysm-patient combinations were thought to have >1 treatment option.
- Fig 5.
Responses to question 2 (Would you recruit this patient in a RCT?). Aneurysm-patient combinations, which more than half of judges were willing to include in a randomized trial, were all ophthalmic or paraophthalmic: for example, a 22-mm ophthalmic segment in a 57-year-old patient (A, 18/22 votes for trial participation) and a recurrent giant ophthalmic artery aneurysm in a 37-year-old patient (B, 20/22 votes). The case with the fewest number of judges willing to randomize was a 16-mm asymptomatic cavernous aneurysm in a 79-year-old patient (C, 4/22 votes).
Tables
All Cases Patients in RCTs Others Patients (No.) 35 14 21 Male/female 14/21 4/10 10/11 Mean age (yr) 52.4 ± 14.5 49.6 ± 18.0 54.3 ± 11.3 Aneurysms Mean size (range) (mm) 23.5 ± 12.9 (3–55) 22.6 ± 9.5 (5–40) 24.1 ± 14.8 (3–55) Anterior circulation 26 (74%) 12 (86%) 14 (67%) Extradural carotid 10 (29%) 5 (36%) 5 (24%) Intradural carotid 15 (43%) 7 (50%) 8 (38%) Posterior circulation 9 (26%) 2 (14%) 7 (33%) Intradural vertebral 6 (17%) 1 (7%) 5 (24%) Basilar 3 (9%) 1 (7%) 2 (10%) Proximala aneurysms 23 (66%) 9 (64%) 14 (66%) Proximala aneurysms, passed TBO 11 (48%) 3 (33%) 8 (38%) Sidewall aneurysm 17 (49%) 5 (36%) 12 (57%) Recurrent aneurysms 5 (14%) 2 (14%) 3 (14%) Ruptured (recent SAH) 4 (11%) 1 (7%) 3 (14%) Symptomatic aneurysms 20 (57%) 6 (43%) 14 (67%) Note:—TBO indicates test balloon occlusion.
↵a Proximal indicates cavernous, ophthalmic, and intradural vertebral locations.
- Table 2:
Inter- and intraobserver agreement regarding question 4 (best final management choice)
Categoriesa All Cases (n = 35) Patients in RCTs (n = 14) Others (n = 21) Interobserver agreement All raters (n = 22) 5 0.219 ± 0.017 0.225 ± 0.020 0.190 ± 0.025 2 0.111 ± 0.018 0.151 ± 0.036 0.072 ± 0.020 Surgeons (n = 6) 5 0.252 ± 0.025 0.202 ± 0.043 0.271 ± 0.033 2 0.114 ± 0.084 0.063 ± 0.131 0.148 ± 0.109 >10 years' experience (n = 13) 5 0.210 ± 0.019 0.203 ± 0.030 0.199 ± 0.025 2 0.062 ± 0.030 0.120 ± 0.050 0.024 ± 0.038 >15 FD experiences (n = 9) 5 0.182 ± 0.029 0.258 ± 0.042 0.116 ± 0.040 2 0.093 ± 0.032 0.201 ± 0.055 0.018 ± 0.040 Intraobserver agreement Rater 1 5 0.465 ± 0.115 0.432 ± 0.162 0.465 ± 0.163 2 0.634 ± 0.109 0.340 ± 0.178 0.463 ± 0.195 Rater 2 5 0.387 ± 0.112 0.421 ± 0.175 0.333 ± 0.143 2 0.243 ± 0.175 0.176 ± 0.272 0.271 ± 0.208 Rater 3 5 0.501 ± 0.104 0.246 ± 0.141 0.629 ± 0.124 2 0.382 ± 0.114 0.263 ± 0.154 0.442 ± 0.160 Rater 4 5 0.634 ± 0.109 0.509 ± 0.178 0.707 ± 0.129 2 0.651 ± 0.129 0.571 ± 0.198 0.712 ± 0.153 ↵a The number 5 indicates that answers were treated as 5 categories: FD, coiling, observation, occlusion of the parent vessel, and surgical clipping. The number 2 indicates that answers were treated as 2 categories: flow diversion versus all other treatment groups.
All Cases (n = 35) Patients in RCTs (n = 14) Others (n = 21) All raters (n = 22) 0.136 ± 0.052 0.162 ± 0.070 0.110 ± 0.075 Surgeons (n = 6) 0.042 ± 0.121 0.013 ± 0.147 0.036 ± 0.191 >10 years' experience (n = 13) 0.070 ± 0.070 0.078 ± 0.101 0.062 ± 0.097 >15 FD experiences (n = 9) 0.131 ± 0.084 0.135 ± 0.137 0.128 ± 0.106 - Table 4:
Inter- and intrarater agreement regarding question 3 (Would you recruit this patient in a RCT?)
All Cases (n = 35) Patients in RCTs (n = 14) Others (n = 21) Interrater agreement All raters (n = 22) 0.162 ± 0.023 0.170 ± 0.031 0.154 ± 0.033 Surgeons (n = 6) 0.190 ± 0.062 0.161 ± 0.077 0.180 ± 0.101 >10 years' experience (n = 13) 0.121 ± 0.023 0.133 ± 0.041 0.109 ± 0.030 >15 FD experiences (n = 9) 0.168 ± 0.032 0.179 ± 0.058 0.142 ± 0.046 Intrarater agreement Rater 1 0.229 ± 0.160 0.263 ± 0.154 0.250 ± 0.238 Rater 2 0.687 ± 0.145 0.625 ± 0.240 0.729 ± 0.180 Rater 3 0.249 ± 0.205 0.440 ± 0.305 0.000 ± 0.000 Rater 4 0.370 ± 0.217 0.264 ± 0.313 0.462 ± 0.305
Jump to section
Related Articles
Cited By...
- Flow Diversion in the Treatment of Intracranial Aneurysms: A Pragmatic Randomized Care Trial
- Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms
- Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model