Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study

Cases in which surgical management (A and A1) or endovascular treatment (EVT) (B) were rarely considered to be an option. A and A1 show a recurrent, previously coiled, calcified, partially thrombosed-but-unruptured left MCA aneurysm. Only 64% of the respondents considered surgical management an option. B, A large, wide-neck, ruptured, right MCA aneurysm. Only 39% of the respondents considered EVT to be an option for this case.

Proportions of votes for surgical and for endovascular treatment (EVT) for unruptured (upper graph) and ruptured (lower graph) MCA aneurysms and the proportion of clinicians willing to include the patient in an RCT (line). Red circles indicate cases with <50% of raters willing (3/30 for unruptured and 5/30 ruptured MCA aneurysms).

Proportions of final treatment choices for all raters, according to background and expertise, for all MCA aneurysms. Note the strong correlation between training background and choice of treatment. INR indicates interventional neuroradiologists; NSx, neurosurgeons.

Interrater agreement for final treatment choices (surgical management versus any endovascular treatment) for all raters, according to background, experience, and practice location, for unruptured, ruptured, and all MCA aneurysms. All κ values are well below the dashed substantial line (0.600). INR indicates interventional neuroradiologists; NSx, neurosurgeons; y, year.