{
  "abstract": "Background Women harbor intracranial aneurysms at higher prevalence than men and may demonstrate distinct aneurysm characteristics — including wider necks and fusiform morphology — that influence treatment selection. Whether female sex independently predicts flow diverter (FD) utilization at the national level, beyond clinical and institutional confounders, remains uncharacterized.Methods We analyzed the National Inpatient Sample (NIS, 2016-2023) to identify adults with unruptured intracranial aneurysm (ICD-10: I67.1) treated with clipping, coiling/embolization, or FD. A survey-weighted multinomial logistic regression model — with coiling as the reference outcome — modeled sex as a predictor of treatment selection, adjusting for age, race, insurance, income quartile, hospital characteristics, geographic region, Elixhauser comorbidity score, elective status, weekend admission, and calendar year. A parallel overall-cohort model including rupture status was also performed. Results are reported as relative risk ratios (RRR) with 95% confidence intervals.Results Among 15,370 unruptured aneurysm hospitalizations (weighted ≈76,850), 58.4% were female. Women were significantly more likely than men to receive FD (29.5% vs. 18.8%; p<0.001). After full multivariable adjustment, female sex remained a strong independent predictor of FD utilization relative to coiling (RRR 1.83, 95% CI 1.56-2.16, p<0.001). In contrast, sex did not significantly predict clipping versus coiling selection (RRR 0.99, 95% CI 0.87-1.12, p = 0.88), indicating the sex effect is specific to flow diversion. In the overall cohort, the female coefficient for FD remained highly significant (β = +0.592, p<0.001) while null for clipping (β = +0.009, p = 0.868). Additional independent predictors of FD use included elective admission (RRR 1.82, p<0.001) and lower comorbidity burden (Elixhauser RRR 0.891 per unit, p<0.001). The strong calendar year effect persisted independently (RRR 7.08 per year, p<0.001).Conclusions Female sex is a strong, independent predictor of flow diverter use for unruptured intracranial aneurysms nationally, with women carrying 83% greater relative likelihood of FD versus coiling compared to men after full adjustment. This association is absent for clipping, highlighting its specificity to flow diversion. The finding likely reflects appropriate device matching to sex-related aneurysm characteristics but warrants prospective investigation to distinguish clinical appropriateness from access-related disparities. These data establish a national baseline for equity monitoring in cerebrovascular device utilization.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-054 Female sex as an independent predictor of flow diverter utilization for unruptured intracranial aneurysms: a national inpatient sample analysis",
  "uid": "d10e9d0b-e710-5f2f-b57a-c3080d4189ec"
}