In our house we take a lot of fizzy vitamin C to prevent colds in the winter. As doctors, my wife and I both know that science doesn’t support our decision… We take it anyway.
What the country saw over the year 2000's was a dramatic increase in the number of aneurysm interventions.
from 1.4/1000 patients in 2000 to above 6.0/1000 patients by 2010.
It also turns out that the >75 years age cohort was responsible for the largest increase in coiling volume. Older patients increasingly got aggressive interventions designed to prevent aneurysmal hemorrhage even though their liklihood of rupturing before they died of other causes was low.
Part of this increase was due to the growth in the number of doctors able to treat these aneurysms. Part was the fact that coiling proved to be safer then clipping, and easier to sell to both patients and doctors. Perhaps most important, intervention seemed common-sense and as the procedures grew safer, the 1% rate of annual catastrophe began to look comparatively more sinister.
Now
: Over a decade when interventions increased four-fold, the rate of subarachnoid hemorrhage didn’t actually go down.
The Stroke data suggests something worse than the obvious issue of whether the morbidity/cost of intervening on an aneurysm outweighs a <1% annual benefit (particularly in the elderly).
In a chart that accompanies the Stroke article, authors showed that while the amount of clipping and coiling going on in America increased dramatically from 2000 to 2010, the number of hemorrhages didn’t actually fall at all. In fact, they inexplicably rose by the end of the decade.
The authors of this brilliant study concluded:
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