Strength in Numbers

Sharing data across institutions helps establish best practices for stroke and aneurysm care.

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Illustration by Peter and Maria Hoey

Andrew J. Ringer, M.D., neurosurgeon, Mayfield Clinic/founding member, Endovascular Neurosurgery Research Group  (ENRG)

In our specialty, we encounter an issue where a lot of reporting about new aneurysm treatments or devices comes out through trials sponsored by industry, so there’s a theoretical bias there. Plus, most studies are conducted under very specific constraints, and a group of us thought that if we were able to compile several studies and look at them together, we could have a much better idea how the reported results could apply outside the narrow trial constructs. That’s really what led us to assemble Endovascular Neurosurgery Research Group, a collaborative of cerebrovascular neurosurgeons [from UC, the Mayo Clinic, Northwestern University, UC San Diego, and more] who have agreed to share our outcomes data about stroke care in an unbiased fashion. We basically ask, Can we replicate the results? We want to put the data out there, interpret it, and talk about how it can be applied in a transparent way.

We’ve done this kind of quality outcomes review for a few different things: one for a type of older aneurysm treatment using stents; one for the Pipeline, a flow diverter that allows us to redirect blood away from aneurysms that can’t be treated in conventional ways; and one for a new stroke device that’s designed to pull a blood clot out of a closed artery before the stroke can set in permanently.

When treatments are labeled “risky” we want to know what that means. High risk? Low risk? So we study it and find—as we did with a study on patients who received treatment with a coil device—that the risk is actually small. We’re just trying to look into the trial that’s been published and be objective. By being objective we can take away some of the mystery, which means doctors and patients get better information and can make better decisions.

This kind of thing doesn’t happen very often, where a bunch of people gather around a dinner table, figure out what question we want to address, go home and find our own data, go through the proper channels of approval, get our studies together, and publish. I could do that on my own and show my 20 cases, or we could all work together and show 100 cases. There’s much more power in numbers.

We fund this with our own personal money and don’t accept any funding from industry groups. Because most of us in ENRG work in very busy academic centers, we get access to new technology and procedures sooner. But it’s not always easy—early on, it was like herding cats.

Neurosurgery is getting better about sharing data and creating a central repository for this kind of information. My goal—and that of our ENRG members—is to have a positive, lasting impact on the way stroke care is delivered in the United States. I’m really proud of our efforts so far.

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