{"id":"bac09927-88e0-40b9-ab31-3e9d01c8e8ff","slug":"how-has-the-nationwide-use-of-off-label-experimental-endovascular-devices-been-allowed-for-two-decades-as-first-choice-and-sometimes-the-only-alternative-to-conventional-standard-and-advanced-surgical","title":"How has the nationwide use of off-label experimental endovascular devices been allowed for two decades as first choice and sometimes the only alternative to conventional standard and advanced surgical techniques?","authors":["Ramsis F. Ghaly"],"abstract":"Background: The use of off-label experimental endovascular devices has been prevalent in the treatment of brain aneurysms for two decades, often presented as the first choice over conventional surgical techniques. This trend raises concerns regarding the inferior obliteration rates and high complication rates associated with these devices. The acceptance of such practices has been facilitated by a perceived superiority of endovascular approaches, despite evidence suggesting otherwise. Methods: This article reflects on observations made during a symposium focused on advancements in stroke treatment, where the emphasis was placed on the navigation and placement of off-label devices in complex cerebral vasculatures. The discussion highlighted the experiences of interventionalists and the outcomes associated with the use of these devices in clinical practice. Results: The findings indicate that the obliteration rates for endovascular techniques remain substandard, with reports of complications exceeding 50% in certain cases. In contrast, surgical clipping has demonstrated a significantly higher success rate of over 90%, underscoring the disparity in outcomes between these two approaches. Conclusion: The widespread adoption of off-label endovascular devices as a primary treatment option for brain aneurysms raises ethical concerns regarding patient safety and informed consent. It is imperative for the medical community to critically evaluate the efficacy and safety of these technologies before endorsing them as standard practice. Keywords: endovascular devices, brain aneurysms, surgical clipping, off-label use, complications, obliteration rates, patient safety, neurosurgery","thumbnailUrl":null,"publishDate":"2015-02-11T00:00:00.000Z","doi":"10.4103/2152-7806.151262","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/05/4562/SNI-6-22.pdf"}