• Matthew T Bender, Haley Wendt, Thomas Monarch, Li-Mei Lin, Bowen Jiang, Judy Huang, Alexander L Coon, Rafael J Tamargo, and Geoffrey P Colby.
• Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• World Neurosurg. 2017 Oct 1; 106: 919-924.

BackgroundSince the introduction of Gugliemi detachable coils in the early 1990s, major clinical studies have supported an increasing role for coil embolization of ruptured aneurysms. We assessed aneurysm location and treatment modality in aneurysmal subarachnoid hemorrhage (aSAH) over the past 25 years.MethodsA prospective, institutional review board-approved aneurysm database was screened for patients presenting with aSAH from 1991 to 2016. Microsurgical and endovascular capabilities were present throughout. All patients underwent cerebral angiography prior to treatment.ResultsData were available for 1306/1562 patients (83.6%) presenting with aSAH from 1991-2016. 72% were female, with average age 52.8 years, and average aneurysm size 8.0 mm. The most common vessel of origin was the anterior cerebral artery (37.3%), internal carotid artery (33.3%), and middle cerebral artery (14.6%). Posterior circulation accounted for 14.8% of the aneurysms. Open surgery was performed for 72.4% of aneurysms, endovascular treatment for 22.0%, and 5.7% were not treated. There was an increase in aneurysms treated by endovascular methods over 5-year intervals: 3.0% (1991-1996), 13.4% (1997-2001), 17.2% (2002-2006), 24.3% (2007-2011), and 41.9% (2012-2016). Posterior circulation aneurysms led this trend, increasing from 9.1% endovascular to 71.4%. Endovascular treatment increased from 2.9% and 1.4% of anterior cerebral artery and internal carotid artery aneurysms to 39.6% and 40.7%, respectively, in the most recent 5-year interval. By comparison, endovascular methods remained less commonly used for middle cerebral artery aneurysms (0% initially, now 22.0%).ConclusionsEndovascular treatment of ruptured intracranial aneurysms has steadily increased over the past 25 years at our major academic institution. This is consistent with positive data from clinical trials, advances in endovascular technology, and increasing experience of endovascular specialists.Copyright © 2017 Elsevier Inc. All rights reserved.

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