One of the frustrations that drove me back to focusing more on delivery of care and less on research was the difficulty in changing practice with the results of research. Nearly 20 years ago, my research group started to study the question of which intracranial aneurysms should be treated. The results were startling: the vast majority of small, unruptured aneurysms should be left untreated, even if the published evidence was off target by a large margin.1 However, these results had little effect. In spite of 2 decades of largely confirmatory evidence for very small aneurysms (arbitrarily set at ≤3 mm in diameter) showing that coil embolization is not as safe as some believe and that rupture and growth rates are extremely low, many continue to recommend treatment for most of these aneurysms.
Johnston SC. Leaving Tiny, Unruptured Intracranial Aneurysms Untreated: Why Is It So Hard? JAMA Neurol. 2018;75(1):13–14. doi:10.1001/jamaneurol.2017.2559
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