{
  "abstract": "Background National treatment patterns for intracranial aneurysms have evolved substantially, particularly with the adoption of flow diversion. National treatment-pattern data comparing clipping, coiling/embolization, and flow diversion across contemporary ICD-10 practice remain limited, and the pace and determinants of flow diverter adoption have not been fully characterized at the national level.Methods We performed a retrospective analysis of adult hospitalizations in the National Inpatient Sample (NIS) from 2016 through 2023. Admissions with treated intracranial aneurysms were identified using ICD-10-CM diagnosis and ICD-10-PCS procedure codes and categorized into clipping, coiling/embolization, or flow diversion as mutually exclusive groups. Survey weighting was applied to generate national estimates. Temporal trends in treatment utilization were assessed overall and stratified by rupture status using survey-weighted cross-tabulation and design-based F-tests. A survey-weighted multinomial logistic regression model — adjusted for age, sex, race, insurance, income, hospital characteristics, Elixhauser comorbidity score, elective status, weekend admission, and rupture status — quantified independent predictors of treatment selection, with coiling as the reference outcome.Results A total of 18,704 treated intracranial aneurysm hospitalizations were identified (weighted N ≈93,520). Overall, 16.1% underwent clipping, 60.6% coiling/embolization, and 23.3% flow diversion. In 2016, clipping accounted for 36.0% of cases and coiling for 64.0%, with no flow diverter cases identified. By 2023, flow diversion reached 45.0% overall and 50.2% among unruptured aneurysms — surpassing coiling as the dominant modality — while clipping declined to 10.6%. Temporal trend testing confirmed a significant shift across the study period (design-based F = 100.4, p<0.001). A sensitivity analysis restricted to 2020-2023 confirmed the trend persisted within the flow diverter era (design-based F = 5.11, p = 0.001). On adjusted multinomial logistic regression, each calendar year independently predicted a decrease in clipping (β = −0.218, p<0.001) and a dramatic increase in flow diversion (relative risk ratio 7.08 per year vs coiling, 95% CI 6.26-7.99, p<0.001) among unruptured aneurysms. Ruptured status independently predicted lower flow diverter use (β = −1.647, p<0.001), consistent with guideline-concordant practice.Conclusions National treatment patterns for intracranial aneurysms shifted markedly during the study period, with flow diversion growing from absent to the most commonly used modality for unruptured aneurysms by 2023. These findings document one of the most rapid treatment-adoption transitions in modern neurovascular surgery and support further investigation into drivers of modality selection, training implications, and downstream patient outcomes.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-182 National trends in clipping, coiling/embolization, and flow diversion for treated intracranial aneurysms: a national inpatient sample analysis, 2016-2023",
  "uid": "6a5913a8-48fe-5158-8e7b-97de79bbe699"
}