Current Management of Small Unruptured Intracranial Aneurysms in the United States: results of a national survey.

ABSTRACT Objective To understand how physicians in the United States manage patients with small unruptured intracranial aneurysms and factors that influence the management. Material and methods An online survey questionnaire was designed through SurveyMonkey and distributed electronically to The Society of Interventional Surgery (SNIS), AANS/CNS joint section of Cerebrovascular Surgery, American Academy of Neurology (AAN) and Massachusetts Neurologic Association (MNA). All participations were voluntary and anonymous. Results Among all the participants, 53.8% of them were neurosurgeons, 33.0% were neurointerventional radiologists, 13.2% were neurologists. For management of aneurysms 2-4mm, 87.8% of respondents favored routine surveillance with imaging follow-up, 3.8% preferred routine treatment, 8.5% recommended routine treatment or follow-up only for high risk patients. 25.5% preferred annual follow-up, 67.9% liked follow-up once in a year and then space out at various intervals. For aneurysms between 5-7 mm, 73.6% supported routine treatment, 20.8% favored surveillance with imaging follow-up, 5.7% recommended treating or follow-up only high-risk groups. 58.5% preferred annual follow-up, while 34.9% liked follow-up once in a year and then space out at various intervals. For routine follow-up, 64.1% of the physicians chose MR angiography without contrast, 40.6% preferred CT angiography. Conclusions For aneurysms 2-4 mm, majority of the physicians preferred regular follow-up, while for aneurysms 5-7 mm the majority favor treatment. There remains heterogeneity in practice among physicians in the United States regarding follow-up strategies for small unruptured aneurysms. Further studies are needed to evaluate the optimal management strategy, follow-up frequency and duration of imaging for small unruptured intracranial aneurysms.