Management of intracranial aneurysms: a 2024 nationwide study from China

BACKGROUND: Rising detection of unruptured intracranial aneurysms (UIAs) in China, driven by an aging population and increased neuroimaging utilization, coincides with significant regional disparities in neurointerventional resources. This study characterizes contemporary management practices nationwide. METHODS: A WeChat-based survey distributed to cerebrovascular specialists in 2024 assessed clinical decision-making, resource availability, and case-based preferences. RESULTS: Resource disparities were pronounced: while computed tomography angiography (CTA) was widely accessible (82.4%), dual-arm digital subtraction angiography (DSA=32.4%) and hybrid operating rooms (36.4%) remained limited. Domestic flow diverters surpassed international devices (47.1% vs. 31.4%). Clinician experience significantly influenced management: physicians with >10 years' experience intervened at smaller UIA sizes (>5 mm; 55.5% vs. 40.1% in <2-year cohort, p=0.03) and preferred flow diverters for incidental aneurysms (80.7% vs. 38.3%, p<0.001). Coiling dominated acute aneurysmal subarachnoid hemorrhage (SAH) management, but senior neurosurgeons favored clipping with hematoma evacuation (66.5% vs. 35.3%, p<0.001). CONCLUSIONS: Significant practice variations persist in China, driven by experience gaps and regional resource inequities. Standardized training and equitable resource allocation are urgently needed to optimize aneurysm care.