Intracranial aneurysms: The era of endovascular intervention in Australia

Intracranial aneurysms (ICAs) can be treated by surgical or endovascular techniques. Endovascular procedures have become common in many specialties, including neurosurgery. In this paper we aim to examine the overall numbers and trends in treatment of IA in Australia. This study was a ten-year retrospective analysis of the Medicare Benefits Schedule (MBS) and Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity databases. These databases were searched for codes corresponding to clipping of ICAs and endovascular coiling of ICAs from the financial years 2008-2009 to 2018-2019. The total number of procedures increased from 2.25 to 3.37 per 100,000 from 2008 to 2009 to 2018-2019 financial years in the MBS database and 7.90 to 10.35 per 100,000 people in the AIHW database for the same financial years. The rate of change of MBS was 0.12 (0.08- 0.16, p < 0.0001) and for AIHW 0.23 (0.19- 0.28, p < 0.0001). Endovascular coiling reached parity with surgical clipping in the 2010-2011 financial year. Women were over twice as likely as men to be treated. The frequency of treatment per 100,000 people peaked in the 55-64 year-old age group. Tasmania performed the most number of treatments per capita compared to other Australian states and territories, according to the MBS database. These figures from Australian databases are in line with other countries from studies around the world that examine preferences of intervention and demographics.