{
  "abstract": "Background Flow diversion has emerged as a major treatment modality for intracranial aneurysms, but its adoption trajectory may differ fundamentally between ruptured and unruptured disease. Characterizing this divergence at the national level is critical for understanding contemporary neurointerventional practice and identifying appropriate patient selection boundaries for this technology.Methods We analyzed adult treated intracranial aneurysm hospitalizations in the National Inpatient Sample (NIS) from 2016 through 2023. Cases were stratified into unruptured (ICD-10: I67.1) and ruptured (I60.0-I60.7 as principal diagnosis) cohorts and categorized into clipping, coiling/embolization, or flow diversion using ICD-10-PCS codes. Survey-weighted national estimates were used to compare modality utilization by rupture status and across years using design-based chi-square testing. A survey-weighted multinomial logistic regression model, adjusted for age, sex, race, insurance, hospital characteristics, comorbidity, and calendar year, tested whether rupture status independently predicted flow diverter versus coiling selection.Results Among 18,704 treated aneurysm admissions, 15,370 (82.2%) were unruptured and 3,726 (19.9%) were ruptured. Overall treatment distribution differed significantly by rupture status (design-based F = 379.4, p<0.001). In unruptured aneurysms, 16.5% underwent clipping, 56.6% coiling/embolization, and 27.0% flow diversion. In ruptured aneurysms, 14.6% underwent clipping, 79.0% coiling/embolization, and only 6.4% flow diversion. In unruptured aneurysms, flow diversion increased from 0% in 2016-2018 to 14.0% in 2019, 44.1% in 2020, and 50.2% in 2023, exceeding coiling as the dominant modality (design-based F = 106.0, p<0.001). Among ruptured aneurysms, coiling remained dominant across all years (74.1% in 2023), while flow diversion rose modestly from 0% to 15.8% in years 2016-2023 (design-based F = 15.7, p<0.001). On adjusted regression, ruptured status was a powerful independent predictor of lower flow diverter use relative to coiling (β = −1.647, 95% CI −1.969 to −1.325, p<0.001), corresponding to an 81% reduction in relative flow diverter likelihood.Conclusions Flow diversion uptake has been dramatically greater in unruptured than ruptured intracranial aneurysms nationally, with rupture status independently reducing relative flow diverter likelihood by 81% in adjusted models. Coiling appropriately remains the dominant treatment for ruptured disease. These findings quantify a clinically appropriate divergence in contemporary aneurysm management and establish a national benchmark for future patient-selection and outcomes research.Disclosures A. Elbayomy: None. S. Hassan: None. L. Mcguire: None. A. Ahmed: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "A Elbayomy"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "S Hassan"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "L Mcguire"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI"
      ],
      "name": "A Ahmed"
    }
  ],
  "title": "E-007 Rupture status strongly shapes national adoption of flow diversion for intracranial aneurysms: a national inpatient sample analysis",
  "uid": "167a7b28-e4e4-5915-af50-ca84afbb6a28"
}