{
  "abstract": "Management of unruptured intracranial aneurysms in patients aged 80 years and older remains uncertain because treatment morbidity, rupture risk, post-rupture outcome, and competing mortality interact. We constructed a competing-risk Markov decision model comparing observation with endovascular coiling in Korean patients at index ages 80, 85, and 90 years; microsurgical clipping and stent-assisted coiling or flow diversion served as additional scenarios. The primary outcome was the undiscounted lifetime cumulative incidence of aneurysm- or treatment-attributable events—treatment morbidity, treatment death, rupture death, or rupture poor outcome—counted as a first-event composite in which all four components carry equal weight regardless of severity, duration, or reversibility. Periprocedural coiling morbidity and mortality were anchored to a U.S. National Inpatient Sample analysis from 2001–2008, and residual post-treatment rupture risk was fixed at 10% of the natural-history rate. Under this original endpoint, median differences favored observation in every age-90 panel and in all male panels at age ≥ 85, and favored coiling in selected age-80 panels and selected age-85 female panels; the probability that coiling was favored ranged from 0.000 to 0.984. A 24-panel, 3%-discounted severity-weighted quality-adjusted analysis was added, together with structural sensitivities for treatment-morbidity recovery, residual rupture risk, and coiling morbidity. Across 30 endpoint-direction comparisons, with each Ma panel mapped to its two legacy marginals, 21 were concordant; all nine discordant comparisons shifted from observation toward coiling, and eight had 95% quality-adjusted uncertainty intervals spanning zero. Median-direction changes under the executed structural sensitivities were confined to modified Rankin Scale-based panels with reference quality-adjusted differences near zero and uncertainty intervals spanning zero. Modeled treatment preference was therefore conditional on endpoint definition and key structural assumptions, including historical treatment-risk estimates and uncalibrated residual post-treatment rupture risk; these model outputs do not establish treatment recommendations for individual patients.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea",
    "Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Republic of Korea"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hyun Dong Yoo"
    },
    {
      "affs": [
        1
      ],
      "name": "Jae Guk Kim"
    },
    {
      "name": "Seung Young Chung"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ff0kvmdgbf1c8.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0357374",
  "fulltext_url": null,
  "id": "ff0kvmdgbf1c8",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0357374",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Intracranial Aneurysms: Treatment and Complications"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Medical risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health statistics/Morbidity"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Patients/Inpatients"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Microsurgery"
    ],
    [
      "plos",
      "/Medicine and health sciences/Vascular medicine/Vascular diseases/Aneurysms"
    ],
    [
      "plos",
      "/Physical sciences/Mathematics/Probability theory/Markov models"
    ],
    [
      "plos",
      "/Research and analysis methods/Research assessment/Peer review"
    ],
    [
      "plos",
      "/Social sciences/Political science/Public policy/Medicare"
    ]
  ],
  "openalex": "W7204900279",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0357374&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-01",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/ff0kvmdgbf1c8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "10.1371/journal.pone.0357374",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0357374"
    }
  ],
  "subjects": [
    {
      "field": "mathematics",
      "origin": "plos:probability theory",
      "subfield": "probability"
    },
    {
      "field": "medicine",
      "origin": "plos:epidemiology",
      "subfield": "epidemiology-public-health"
    },
    {
      "field": "medicine",
      "origin": "plos:surgical and invasive medical procedures",
      "subfield": "surgery"
    }
  ],
  "title": "Observation versus coiling for unruptured intracranial aneurysms in octogenarians: A decision-analytic modeling study",
  "title_text": "Observation versus coiling for unruptured intracranial aneurysms in octogenarians: A decision-analytic modeling study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/ff0kvmdgbf1c8",
  "venue": "PLOS One",
  "versions": []
}