Unruptured Intracranial Aneurysm Treatment Score Concordance for Unruptured Aneurysm Treatment at a Quaternary Center.

Objective This retrospective study analyzed records from a quaternary hospital's multidisciplinary team (2002-2020) to investigate patients diagnosed with incidental intracranial aneurysms and their treatment approaches. Methods Clinical decisions (surgery vs. conservative) were compared with retrospectively calculated Unruptured Intracranial Aneurysm Treatment Score (UIATS) recommendations to identify variables influencing treatment divergence. Results Agreement between clinical decisions and UIATS was 69.3% (n=70), though Cohen's kappa (0.25) indicated only fair statistical agreement. Discordance was significantly associated with aneurysm diameter (p=0.002), size (p=0.007), morphology (p<0.0001), multiplicity (p<0.0001), and risk scores (p=0.008). Notably, 10.9% (n=11) of patients received conservative care despite UIATS recommending surgery, while 19.8% (n=20) underwent surgery despite conservative recommendations. Conclusion Clinical decisions showed fair agreement with the UIATS. Discrepancies were primarily driven by specific aneurysm characteristics and evolving treatment protocols over the 18-year study period, highlighting that while UIATS is a valuable support tool, individualized multidisciplinary evaluation remains essential.