T E Darsaut1, J-C Gentric2, C M McDougall1, G Gevry3, D Roy2, A Weill2, J Raymond4. 1. From the Division of Neurosurgery (T.E.D., C.M.M.), Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada. 2. Department of Radiology (J.-C.G., D.R., A.W., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada. 3. Laboratory of Interventional Neuroradiology (G.G., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre, Montreal, Quebec, Canada. 4. Department of Radiology (J.-C.G., D.R., A.W., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada Laboratory of Interventional Neuroradiology (G.G., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre, Montreal, Quebec, Canada. jean.raymond@umontreal.ca.
Abstract
BACKGROUND AND PURPOSE: The role of flow diversion in the management of aneurysms remains unknown. We sought to evaluate the community agreement regarding indications for flow diversion. MATERIALS AND METHODS: A portfolio of 35 difficult aneurysm cases was sent to 40 clinicians with varying backgrounds and experience. Responders were asked whether they considered flow diversion a treatment option, whether other options were possible, whether recruitment in a randomized trial would be considered, and to select their final choice. Agreement was studied by using κ statistics. RESULTS: Decisions for flow diversion were more frequent (n = 300, 39%) than decisions to coil (n = 163, 21.2%), to observe (n = 121, 15.7%), to occlude the parent vessel (n = 102, 13.2%), or to clip (n = 66, 8.6%). Sidewall aneurysm morphology was associated with flow diversion as the final choice (P = .001). Interjudge agreement was fair at best (κ <0.3) for all cases and all judges, despite high certainty levels (range, 7.2-8.9 ± 2.0 on a 0-10 scale). Agreement was no better within specialties or with more experience. All patients were judged to have other treatment options. Judges were willing to offer trial participation in 417 of 741 (56.3%) scenarios, more frequently when the aneurysm was sidewall (P = .001) or in the anterior circulation (P = .028). CONCLUSIONS: Individuals did not agree regarding the indications for flow diversion. There is sufficient uncertainty to justify trials designed to protect patients from the potential risks of premature adoption of an innovation.
BACKGROUND AND PURPOSE: The role of flow diversion in the management of aneurysms remains unknown. We sought to evaluate the community agreement regarding indications for flow diversion. MATERIALS AND METHODS: A portfolio of 35 difficult aneurysm cases was sent to 40 clinicians with varying backgrounds and experience. Responders were asked whether they considered flow diversion a treatment option, whether other options were possible, whether recruitment in a randomized trial would be considered, and to select their final choice. Agreement was studied by using κ statistics. RESULTS: Decisions for flow diversion were more frequent (n = 300, 39%) than decisions to coil (n = 163, 21.2%), to observe (n = 121, 15.7%), to occlude the parent vessel (n = 102, 13.2%), or to clip (n = 66, 8.6%). Sidewall aneurysm morphology was associated with flow diversion as the final choice (P = .001). Interjudge agreement was fair at best (κ <0.3) for all cases and all judges, despite high certainty levels (range, 7.2-8.9 ± 2.0 on a 0-10 scale). Agreement was no better within specialties or with more experience. All patients were judged to have other treatment options. Judges were willing to offer trial participation in 417 of 741 (56.3%) scenarios, more frequently when the aneurysm was sidewall (P = .001) or in the anterior circulation (P = .028). CONCLUSIONS: Individuals did not agree regarding the indications for flow diversion. There is sufficient uncertainty to justify trials designed to protect patients from the potential risks of premature adoption of an innovation.
Authors: Zsolt Kulcsár; Ulrike Ernemann; Stephan G Wetzel; Alexander Bock; Sophia Goericke; Vasilis Panagiotopoulos; Michael Forsting; Daniel A Ruefenacht; Isabel Wanke Journal: Stroke Date: 2010-07-08 Impact factor: 7.914
Authors: T E Darsaut; E Rayner-Hartley; A Makoyeva; I Salazkin; F Berthelet; J Raymond Journal: Interv Neuroradiol Date: 2013-05-21 Impact factor: 1.610
Authors: Robert Fahed; Tim E Darsaut; Jean-Christophe Gentric; Behzad Farzin; Igor Salazkin; Guylaine Gevry; Jean Raymond Journal: Neuroradiology Date: 2017-02-27 Impact factor: 2.804
Authors: J Raymond; D Iancu; W Boisseau; J D B Diestro; R Klink; M Chagnon; J Zehr; B Drake; H Lesiuk; A Weill; D Roy; M W Bojanowski; C Chaalala; J L Rempel; C O'Kelly; M M Chow; S Bracard; T E Darsaut Journal: AJNR Am J Neuroradiol Date: 2022-08-04 Impact factor: 4.966
Authors: Robert Fahed; Jean Raymond; Célina Ducroux; Jean-Christophe Gentric; Igor Salazkin; Daniela Ziegler; Guylaine Gevry; Tim E Darsaut Journal: Neuroradiology Date: 2016-01-08 Impact factor: 2.804