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Neuroimaging
Original research
National trends in catheter angiography and cerebrovascular imaging in a group of privately insured patients in the US
  1. Francis Jareczek1,
  2. Kyle Tuohy1,
  3. Edeanya Agbese2,
  4. Ephraim Church1,
  5. Kevin Cockroft1,
  6. Scott Simon1,
  7. Douglas L Leslie2,
  8. D Andrew Wilkinson1
  1. 1Neurosurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  2. 2Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
  1. Correspondence to Dr D Andrew Wilkinson; dwilkinson{at}pennstatehealth.psu.edu

Abstract

Background Despite the increasing use of non-invasive imaging, DSA remains the gold standard for cerebrovascular imaging. However, trends in DSA utilization are poorly understood. The goal of this study was to describe DSA utilization in a large claims database in the US over a 13 year period.

Methods This retrospective cohort study assessed a nationwide database of privately insured individuals from 2005 to 2018 for patients undergoing cranial CT angiography (CTA), MR angiography (MRA), and DSA. We assessed trends in the overall use of and indications for each modality. For DSA, we examined the types of performing proceduralists.

Results Among patients undergoing DSA in 2018, median age was 52 years, and 60% were women. MRA and DSA use decreased, from 289 to 275 claims, and from 38 to 29 claims per 100 000 enrollees, respectively, while CTA use increased from 31 to 286 claims per 100 000 enrollees. These trends differed by geographic region and indication. Nearly half of DSA procedures but <25% of non-invasive imaging were inpatient studies. DSA performed by neurosurgeons increased from 0.5 to 4.1 while those performed by radiologists decreased from 7.2 to 4.0 studies per 100 000 enrollees.

Conclusions DSA use decreased slightly while CTA use increased by ninefold. The reasons for this change are likely complex and may reflect more aggressive imaging for stroke, increased detection of incidental findings, and increased quality of non-invasive imaging. Over time, the proportion of DSA procedures performed by neurosurgeons overtook that performed by radiologists.

  • Angiography
  • CT Angiography
  • Magnetic Resonance Angiography
  • Catheter

Data availability statement

Data are available upon reasonable request. Data consisting of aggregate CPT and ICD claim counts were extracted from the MarketScan database and subsequently analyzed for the purposes of this study. These aggregate data are available on request.

https://doi.org/10.1136/jnis-2024-022296

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    Data availability statement

    Data are available upon reasonable request. Data consisting of aggregate CPT and ICD claim counts were extracted from the MarketScan database and subsequently analyzed for the purposes of this study. These aggregate data are available on request.

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    Footnotes

    • X @KyleTuohyMD, @DAWilkinsonMD

    • Contributors FJ was involved in designing the study, monitoring data retrieval and reporting, analyzing the data, and drafting and revising the manuscript. KT analyzed the data and drafted and revised the manuscript. EA helped design the study, developed the data collection tools, and extracted, cleaned, and reported the data. EC provided critical feedback in the design of the study, in the interpretation and reporting of the results, and in manuscript preparation and revision. KC provided critical feedback in the design of the study, in the interpretation and reporting of the results, and in manuscript preparation and revision. SS provided critical feedback in the design of the study, in the interpretation and reporting of the results, and in manuscript preparation and revision. DLL designed the study, developed the data collection tools, and assisted with extraction, reporting, and interpretation of the data. DAW designed the study and statistical analysis plan, monitored data retrieval and reporting, analyzed the data, and drafted and revised the manuscript. DAW is responsible for the overall content as guarantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.