Abstract W P68: Treatment of Unruptured Intracranial Aneurysms Within the Pediatric Population

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Malik M Adil ◽  
Lori C Jordan ◽  
Adnan I Qureshi
Keyword(s):  
Hospital Mortality ◽  
Intracranial Aneurysms ◽  
Pediatric Population ◽  
Primary Diagnosis ◽  
Favorable Outcome ◽  
High Rate ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Unruptured Intracranial Aneurysms

Background: The rates and outcomes of treatments for intracranial aneurysms have not been exclusively determined within the pediatric population. We determined the rates of endovascular and microsurgical treatments for unruptured intracranial aneurysms (UIA) and associated rates of favorable outcome. Methods: We analyzed the data obtained as part of the Kids’ Inpatient Database between 2003 and 2009 with primary diagnosis of UIA (identified by the International Classification of Disease codes, Ninth Revision). Patients undergoing endovascular treatment (ET) were compared to those undergoing microsurgical treatment (MT). Outcomes were defined as rates of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), in-hospital mortality, or favorable outcome (discharge disposition of home/self-care). Results: There were 818 cases of UIAs during the timeline examined. A total of 111 patients (mean age 14±6 years, 37.6% female) underwent MT and another 200 patients (mean age 13±7 years, 42.5% female) underwent ET. There were no significant differences in rates of ICH (MT 4.4% versus ET 2%, p=0.4) and SAH (MT 15.5% versus ET 9.3%, p=0.2). There was no in-hospital mortality among those who received MT, and 3 patients died among those who received ET. A high rate of favorable outcome was observed in patients who received either treatment (MT 87.7% versus ET 91.6%, p=0.4). There was a trend towards a significantly shorter mean hospitalization stay among those who received ET as opposed to MT (6±12 days versus 9±11 days, p=0.06). There was also a significant trend towards higher utilization of ET as opposed to MT from 2003 to 2009 (p=0.02). Conclusion: Although outcomes except for length of stay are comparable between ET and MT patients, there is a trend towards higher utilization of ET among children with UIAs from 2003 to 2009.

Endotracheal Intubation and In-Hospital Mortality after Intracerebral Hemorrhage

2018 ◽  
Vol 45 (5-6) ◽  
pp. 270-278 ◽  
Author(s):  
Vasileios-Arsenios Lioutas ◽  
Sarah Marchina ◽  
Louis R. Caplan ◽  
Magdy Selim ◽  
Joseph Tarsia ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Endotracheal Intubation ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Final Analysis ◽  
Primary Diagnosis ◽  
Care Hospital ◽  
Net Benefit ◽  
Large Hospital ◽  
Discharge Disposition

Background: Many patients with acute intracerebral hemorrhages (ICHs) undergo endotracheal intubation with subsequent mechanical ventilation (MV) for “airway protection” with the intent to prevent aspiration, pneumonias, and its related mortality. Conversely, these procedures may independently promote pneumonia, laryngeal trauma, dysphagia, and adversely affect patient outcomes. The net benefit of intubation and MV in this patient cohort has not been systematically investigated. Methods: We conducted a large single-center observational cohort study to examine the independent association between endotracheal intubation and MV, hospital-acquired pneumonia (HAP), and in-hospital mortality (HM) in patients with ICH. All consecutive patients admitted with a primary diagnosis of a spontaneous ICH to a tertiary care hospital in Boston, Massachusetts, from June 2000 through January 2014, who were ≥18 years of age and hospitalized for ≥2 days were eligible for inclusion. Patients with pneumonia on admission, or those having brain or lung neoplasms were excluded. Our exposure of interest was endotracheal intubation and MV during hospitalization; our primary outcomes were incidence of HAP and HM, ascertained using International Classification of Diseases-9 and administrative discharge disposition codes, respectively, in patients who underwent endotracheal intubation and MV versus those who did not. Multivariable logistic regression was used to control for confounders. Results: Of the 2,386 hospital admissions screened, 1,384 patients fulfilled study criteria and were included in the final analysis. A total of 507 (36.6%) patients were intubated. Overall 133 (26.23%) patients in the intubated group developed HAP versus 41 (4.67%) patients in the non-intubated group (p < 0.0001); 195 (38.5%) intubated patients died during hospitalization compared to 48 (5.5%) non-intubated patients (p < 0.0001). After confounder adjustments, OR for HAP and HM, were 4.23 (95% CI 2.48–7.22; p < 0.0001) and 4.32 (95% CI 2.5–7.49; p < 0.0001) with c-statistics of 0.79 and 0.89, in the intubated versus non-intubated patients, respectively. Conclusion: In this large hospital-based cohort of patients presenting with an acute spontaneous ICH, endotracheal intubation and MV were associated with increased odds of HAP and HM. These findings urge further examination of the practice of intubation in prospective studies.

scholarly journals Analysis of cerebrovascular aneurysm treatment cost: retrospective cohort comparison of clipping, coiling, and flow diversion

2018 ◽  
Vol 44 (5) ◽  
pp. E3 ◽  
Author(s):  
Spencer Twitchell ◽  
Hussam Abou-Al-Shaar ◽  
Jared Reese ◽  
Michael Karsy ◽  
Ilyas M. Eli ◽  
...  
Keyword(s):  
Health Care ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Flow Diversion ◽  
High Quality ◽  
Total Cost ◽  
Cost Drivers ◽  
Discharge Disposition ◽  
Unruptured Intracranial Aneurysms ◽  
Care Costs

OBJECTIVEWith the continuous rise of health care costs, hospitals and health care providers must find ways to reduce costs while maintaining high-quality care. Comparing surgical and endovascular treatment of intracranial aneurysms may offer direction in reducing health care costs. The Value-Driven Outcomes (VDO) database at the University of Utah identifies cost drivers and tracks changes over time. In this study, the authors evaluate specific cost drivers for surgical clipping and endovascular management (i.e., coil embolization and flow diversion) of both ruptured and unruptured intracranial aneurysms using the VDO system.METHODSThe authors retrospectively reviewed surgical and endovascular treatment of ruptured and unruptured intracranial aneurysms from July 2011 to January 2017. Total cost (as a percentage of each patient’s cost to the system), subcategory costs, and potential cost drivers were evaluated and analyzed.RESULTSA total of 514 aneurysms in 469 patients were treated; 273 aneurysms were surgically clipped, 102 were repaired with coiling, and 139 were addressed with flow diverter placements. Middle cerebral artery aneurysms accounted for the largest portion of cases in the clipping group (29.7%), whereas anterior communicating artery aneurysms were most frequently involved in the coiling group (30.4%) and internal carotid artery aneurysms were the majority in the flow diverter group (63.3%). Coiling (mean total cost 0.25% ± 0.20%) had a higher cost than flow diversion (mean 0.20% ± 0.16%) and clipping (mean 0.17 ± 0.14%; p = 0.0001, 1-way ANOVA). Coiling cases cost 1.5 times as much as clipping and flow diversion costs 1.2 times as much as clipping. Facility costs were the most significant contributor to intracranial clipping costs (60.2%), followed by supplies (18.3%). Supplies were the greatest cost contributor to coiling costs (43.2%), followed by facility (40.0%); similarly, supplies were the greatest portion of costs in flow diversion (57.5%), followed by facility (28.5%). Cost differences for aneurysm location, rupture status, American Society of Anesthesiologists (ASA) grade, and discharge disposition could be identified, with variability depending on surgical procedure. A multivariate analysis showed that rupture status, surgical procedure type, ASA status, discharge disposition, and year of surgery all significantly affected cost (p < 0.0001).CONCLUSIONSFacility utilization and supplies constitute the majority of total costs in aneurysm treatment strategies, but significant variation exists depending on surgical approach, rupture status, and patient discharge disposition. Developing and implementing approaches and protocols to improve resource utilization are important in reducing costs while maintaining high-quality patient care.

scholarly journals National trends in cerebral bypass for unruptured intracranial aneurysms: a National (Nationwide) Inpatient Sample analysis of 1998–2015

2019 ◽  
Vol 46 (2) ◽  
pp. E15 ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Enzo M. Fortuny ◽  
Nicolas K. Khattar ◽  
Noberto Andaluz ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Unruptured Intracranial Aneurysms ◽  
Number Of Patients ◽  
Cerebral Bypass ◽  
Median Hospital ◽  
Flow Diverters

OBJECTIVEThe development and recent widespread dissemination of flow diverters may have reduced the utilization of surgical bypass procedures to treat complex or giant unruptured intracranial aneurysms (UIAs). The aim of this retrospective cohort study was to observe trends in cerebral revascularization procedures for UIAs in the United States before and after the introduction of flow diverters by using the National (Nationwide) Inpatient Sample (NIS).METHODSThe authors extracted data from the NIS database for the years 1998–2015 using the ICD-9/10 diagnostic and procedure codes. Patients with a primary diagnosis of UIA with a concurrent bypass procedure were included in the study. Outcomes and hospital charges were analyzed.RESULTSA total of 216,212 patients had a primary diagnosis of UIA during the study period. The number of patients diagnosed with a UIA increased by 128% from 1998 (n = 7718) to 2015 (n = 17,600). Only 1328 of the UIA patients (0.6%) underwent cerebral bypass. The percentage of patients who underwent bypass in the flow diverter era (2010–2015) remained stable at 0.4%. Most patients who underwent bypass were white (51%), were female (62%), had a median household income in the 3rd or 4th quartiles (57%), and had private insurance (51%). The West (33%) and Midwest/North Central regions (30%) had the highest volume of bypasses, whereas the Northeast region had the lowest (15%). Compared to the period 1998–2011, bypass procedures for UIAs in 2012–2015 shifted entirely to urban teaching hospitals (100%) and to an elective basis (77%). The median hospital stay (9 vs 3 days, p < 0.0001), median hospital charges ($186,746 vs $66,361, p < 0.0001), and rate of any complication (51% vs 17%, p < 0.0001) were approximately threefold higher for the UIA patients with bypass than for those without bypass.CONCLUSIONSDespite a significant increase in the diagnosis of UIAs over the 17-year study period, the proportion of bypass procedures performed as part of their treatment has remained stable. Therefore, advances in endovascular aneurysm therapy do not appear to have affected the volume of bypass procedures performed in the UIA population. The authors’ findings suggest a potentially ongoing niche for bypass procedures in the contemporary treatment of UIAs.

Endovascular Treatment of Unruptured Intracranial Aneurysms: Occurrence of Thromboembolic Events

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 612-618 ◽  
Author(s):  
Iris Quasar Grunwald ◽  
Panagiotis Papanagiotou ◽  
Maria Politi ◽  
Tobias Struffert ◽  
Christian Roth ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Intracranial Aneurysms ◽  
Thrombus Formation ◽  
High Rate ◽  
Thromboembolic Events ◽  
Patient Age ◽  
Diffusion Weighted ◽  
Aneurysm Size ◽  
Patient Âgé ◽  
Unruptured Intracranial Aneurysms

Abstract OBJECTIVE: The purpose of this study was to evaluate the frequency and causes of thromboembolic events associated with endovascular embolization of asymptomatic aneurysms. Correlations between radiological findings (aneurysm size, localization, embolization time, number of coils used, as well as patient age) were evaluated with the occurrence of thromboembolic events and clinical findings. METHODS: Sixty-eight patients treated for unruptured intracranial aneurysms (mean age, 49 yr) were evaluated. Hyperintense lesions on diffusion weighted imaging were analyzed in 50 patients. Aneurysm size was 3 to 15 mm. RESULTS: Complete occlusion of the aneurysms was achieved in 55 of 68 (82%). One patient had a transient paresis. There was one infarction and one aneurysm rupture during the procedure with no consecutive neurological symptoms. We found new hyperintense lesions in 21 of 50 (42%) diffusion weighted imaging studies. In 43% of these, there was only one lesion smaller than 2 mm. In 33%, there was more than one lesion less than 2 mm; in 19%, we found a lesion of 2 to 10 mm in size. In one case, a lesion greater than 10 mm occurred. There was no correlation between aneurysm location and the occurrence of lesions or among the number of coils used, the size of the aneurysm, patient age, or embolization time. Mortality rate was 0%, morbidity 4.0%. If the 18 aneurysms where no diffusion weighted imaging was obtained are included, morbidity is 2.9%. CONCLUSION: The high rate of thromboembolic events suggests that heparin is not sufficient to prevent ischemic lesions. An antiplatelet therapy, started before or during intervention, might diminish thrombus formation.

Abstract 1122‐000195: Endovascular Coiling Versus Neurosurgical Clipping for Treatment of Ruptured and Unruptured Intracranial Aneurysms During Pregnancy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Aayushi Garg ◽  
Mudassir Farooqui ◽  
Juan Vivanco‐Suarez ◽  
Milagros Galecio‐Castillo ◽  
Santiago Ortega Gutierrez
Keyword(s):  
Mechanical Ventilation ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Patient Population ◽  
Intracranial Aneurysms ◽  
Infectious Complications ◽  
Endovascular Coiling ◽  
Unruptured Aneurysms ◽  
Discharge Disposition ◽  
Ruptured Aneurysms

Introduction : Management of intracranial aneurysms during pregnancy is challenging. The hemodynamic changes during pregnancy increase the risk of intracranial aneurysm rupture. Further, the selection of an appropriate surgical strategy requires a careful review of the potential risks to the mother and fetus. Yet, there is limited data to guide the treatment decisions in this patient population. In this study, we aimed to compare the safety profiles of endovascular coiling (EC) and neurosurgical clipping (NC) in this patient population. Methods : Pregnancy‐related hospitalizations with age≥18 years undergoing surgical intervention for intracranial aneurysms were identified from the Nationwide Readmissions Database 2016–2018. Hospitalizations with diagnoses of arteriovenous malformation, cerebral arteritis, and traumatic SAH were excluded. Logistic regression analysis was used to compare outcomes between EC and NC. Results : There were 11829044 pregnancy‐related hospitalizations, of which 348 met the study inclusion criteria (mean±SD age: 31.8±5.9). Among 168 patients treated for ruptured aneurysms, 115 (68.5%) underwent EC and 53 (31.5%) underwent NC. Whereas among 180 patients treated for unruptured aneurysms, 140 (77.8%) underwent EC and 40 (22.2%) underwent NC. There were no statistically significant differences in the demographics, clinical presentation, and hospital‐level characteristics between patients undergoing EC versus NC for either ruptured or unruptured aneurysm groups. Among patients with ruptured aneurysms, 11.9% patients had perioperative ischemic stroke, 22.6% patients required mechanical ventilation for >24 hours, 6.5% patients underwent tracheostomy, 6.5% patients had acute kidney injury, 20.2% patients had infectious complications, 4.2% patients underwent gastrostomy tube placement, 30.0% patients had discharge disposition other than to home, 10.1% patients had in‐hospital mortality, and 4.8% patients had non‐elective readmission within 30 days of discharge. These outcomes were comparable between patients with EC and NC, except patients undergoing EC were less likely to develop ischemic stroke [odds ratio (OR): 0.21, 95% confidence interval (CI): 0.05‐0.98] (Figure 1A). None of the 30‐day readmissions were due to procedural complications and a majority (75%) of them were due to pregnancy‐related conditions. Among patients with unruptured aneurysms, 5.6% patients had perioperative ischemic stroke, 5.0% patients required mechanical ventilation for >24 hours, 6.1% patients had infectious complications, 11.1% patients had discharge disposition other than to home, 0.01% patient had in‐hospital mortality, and 0.01% patient had non‐elective readmission within 30 days of discharge. There were no significant differences in these outcomes or in the average length of hospital stay among patients undergoing EC versus NC for unruptured aneurysms (Figure 1B). Conclusions : Surgical treatment of intracranial aneurysms during pregnancy is safe with a relatively low rate of early complications. While a majority of patients undergo EC, we found that the safety profiles of NC and EC are largely comparable. Future large studies are needed to further evaluate the advantages and disadvantages of these procedures in detail in this patient population.

Abstract P456: Myocardial Infarction in Patients With Intracerebral Hemorrhage. Prevalence and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Hospital Charges ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Discharge Outcomes ◽  
Baseline Characteristics

Introduction/background: Comorbidities can potentially affect outcome of patients with intracerebral hemorrhage (ICH). It is unclear what the prevalence of acute myocardial infarction (AMI) and its impact on outcome are in patients with intracerebral hemorrhage. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. AMI was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, discharge disposition, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 884379 patients with ICH, 27692 (3.13%) had in-hospital myocardial infraction. ICH patients with AMI order had lower proportion of females (47.8% versus 49.7%, P= 0.0028) and were older (69.7 years versus 67.2 years, P <.0001) compared to ICH patients without MI. The in-hospital mortality was higher (40.9% versus 25.5%, p≤.0001) among ICH patients with AMI in both univariate and multivariate analysis (OR = 1.22 (1.14 -1.31), P<.0001) after adjusting for potential confounders. ICH patients with MI had higher (72.4% versus 58.8%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (12.4 days versus 8.94 days, P <.0001) and mean hospital charges ($129328 versus $ 81984.0, P <.0001) were also higher in ICH patients with MI Conclusions: While only 3.13% of patients with ICH have an AMI, there is a 22% increase in worse outcome among those patients with AMI and ICH.

One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year
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