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The Changing Landscape of Treatment for Intracranial Aneurysm

  • Christopher S. Lozano (a1), Andres M. Lozano (a1) and Julian Spears (a1)

Abstract:

There has been a significant transformation in the treatment of intracranial aneurysms (IAs) over the past century, with the most pivotal changes occurring in the past three decades. To characterize this evolution, we assessed the number of articles published on various procedures for the treatment of IA as a measure of their interest and usage over time. We separated our analysis into two main areas: surgical and endovascular approaches. We further subdivided these two main categories into clipping and bypass for surgery, and coiling, flow diversion, and liquid material embolization for endovascular approaches. We found 5956 publications on open surgical approaches in the 70-year period from 1947 to 2017, with papers on clipping (n = 4204), being the most common. We found 8602 endovascular publications beginning in 1964, with most of the activity taking place in the late 1990s and beyond. Coiling had the most publications of the endovascular approaches (n = 5436). In 1999, the number of annual publications on endovascular treatments surpassed those of open surgery, signaling a crossover point in the IA literature. The same trend continues to this date.

Comment les traitements des anévrismes intracrâniens se sont diversifiés au fil du temps. Depuis un siècle, particulièrement au cours des trois dernières décennies, des transformations notables sont survenues en ce qui regarde le traitement des anévrismes intracrâniens (AI). Afin de caractériser cette évolution, nous avons tenté d’évaluer le nombre d’articles publiés au sujet des diverses approches visant à traiter les AI. Cela nous a permis de mesurer l’intérêt à l’égard de ces approches ainsi que leur fréquence d’utilisation au fil du temps. Nous avons divisé ainsi notre analyse en deux volets : l’approche chirurgicale et celle de nature endovasculaire. La première approche a été ensuite subdivisée en deux techniques, soit le clipping et le pontage, tandis que la seconde a été subdivisée en trois techniques distinctes : la pose de spires métalliques (ou coiling), la dérivation de l’écoulement et l’embolisation liquide à l’aide d’implants. Nous avons ainsi répertorié 5956 publications portant sur une approche chirurgicale ouverte au cours de la période allant de 1947 à 2017, les articles abordant la technique du clipping étant les plus courants (n = 4204). Nous avons par ailleurs répertorié 8602 articles consacrés aux techniques endovasculaires, et ce, à partir de 1964. À noter que la plupart de ces articles ont été publiés à la fin des années 90 et au courant des années 2000 et 2010. Parmi toutes les techniques endovasculaires, c’est la pose de spires métalliques qui a fait l’objet du plus grand nombre de publications (n = 5436). Il est aussi bon de rappeler que c’est en 1999 que le nombre de publications annuelles portant sur les techniques endovasculaires a fini par dépasser celui des publications mettant l’accent sur l’approche chirurgicale, ce qui indique un point de bascule dans la littérature scientifique abordant la question des AI. Cette tendance demeure inchangée jusqu’à aujourd’hui.

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Copyright

Corresponding author

Correspondence to: Christopher Lozano, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada. Email: christopherlozano@rcsi.com

References

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The Changing Landscape of Treatment for Intracranial Aneurysm

  • Christopher S. Lozano (a1), Andres M. Lozano (a1) and Julian Spears (a1)

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