Physician Specialty for Basilar Tip Aneurysm Coiling
Basilar tip aneurysm coiling is performed by interventional neuroradiologists or dually-trained neurosurgeons with specialized endovascular training. 1
Primary Operators
- Interventional neuroradiologists are the primary specialists performing endovascular coiling procedures for basilar tip aneurysms 1
- Neurosurgeons with dual training in both microsurgical and endovascular techniques also perform these procedures 2
- The American Heart Association guidelines emphasize that these procedures should be performed by experienced endovascular specialists with specific expertise in cerebrovascular interventions 1
Training and Expertise Requirements
- Operators must have specialized training in endovascular neurointerventional procedures, not just general interventional radiology or neurosurgery 1
- The ISAT trial demonstrated that highly specialized interventional neuroradiologists achieved superior outcomes compared to general neurosurgeons performing clipping 1
- Hospital volume matters critically: mortality is 53% lower at centers performing >10 aneurysm procedures annually, emphasizing the importance of operator experience 3
Multidisciplinary Decision-Making
- While the actual coiling procedure is performed by interventional neuroradiologists or endovascular neurosurgeons, treatment decisions should involve both experienced cerebrovascular surgeons and endovascular specialists to determine whether coiling or clipping is optimal 1, 3
- This multidisciplinary approach is a Class I recommendation from the American Heart Association 1
Clinical Context
- For basilar tip aneurysms specifically, endovascular coiling is preferred over surgical clipping when anatomically feasible, particularly for ruptured aneurysms, elderly patients (>70 years), and poor-grade SAH patients 1, 3
- The procedural mortality for basilar tip aneurysm coiling is 2.7% with permanent stroke deficits in 5-9% of patients when performed by experienced operators 3