Abstract WP297: National Estimates of Recurrent Intracranial Hemorrhage Among Patients With Ruptured Intracranial Aneurysms

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra A Akhtar ◽  
Werdah Zafar ◽  
Yun Fang ◽  
Ameer E Hassan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Ruptured Intracranial Aneurysm ◽  
Hospitalization Period ◽  
Nationally Representative ◽  
Ruptured Intracranial Aneurysms

Background: The estimates of recurrent intracranial hemorrhage in the post-hospitalization period among patients treated for ruptured intracranial aneurysms are not available outside clinical trials. Objective: To determine the rates of recurrent intracranial hemorrhage related hospitalization within 3 month post-hospitalization for treatment of ruptured intracranial aneurysm in a nationwide cohort of patients admitted for subarachnoid hemorrhage (SAH). Methods: We identified all readmissions related to new SAH or intracerebral hemorrhage in the nationally representative data for all patients hospitalized for SAH using the Nationwide Readmissions Database (NRD) 2013 and 2014 who had undergone endovascular or surgical treatment. Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent intracranial hemorrhage for patients in treatment cohorts after adjusting for potential confounders. The 1-year survival was estimated for both treatment groups by using the Kaplan-Meier survival method. Results: A total of 8,619 patients with SAH were treated with either endovascular (n = 4,102, 47.6%) or surgical treatment (n =4,517; 52.4%).. The estimated 3 months recurrent intracranial hemorrhage survival was 99.4% and 98.4% in patients who underwent surgical and endovascular treatments, respectively (p=0.0024). After adjusting for age>65, and APDRG severity score, the RRs of recurrent any intracranial hemorrhage was higher with endovascular treatment (RR, 3.0; 95% confidence interval (CI), 1.4 -6.7 p=0.0052). Conclusion: Although the rates of recurrent intracranial hemorrhage related hospitalization were low among patients with ruptured intracranial aneurysms, there was a higher rate among patients treated with endovascular treatment.

Abstract TP427: National Estimates of Recurrent Intracranial Hemorrhage Among Patients with Ruptured Intracranial Aneurysms: Effect of Treatment Modality

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad R Afzal ◽  
Burhan Chaudhry ◽  
Haseeb Rehman ◽  
Ahmed Riaz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Ruptured Intracranial Aneurysm ◽  
Hospitalization Period ◽  
Ruptured Intracranial Aneurysms

Background: The estimates of recurrent intracranial hemorrhage in post hospitalization period among patients treated for ruptured intracranial aneurysms are not available outside clinical trials. Objective: To determine the rates of recurrent intracranial hemorrhage related hospitalization within 1 year post hospitalization for treatment of ruptured intracranial aneurysm in a nationwide cohort of patients admitted for subarachnoid hemorrhage (SAH). Methods: We identified all readmissions related to new SAH or intracerebral hemorrhage in the nationally representative data for all patients hospitalized for SAH using the Nationwide Readmissions Database (NRD) 2013 who had undergone endovascular or surgical treatment.. Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent intracranial hemorrhage for patients in treatment cohorts after adjusting for potential confounders. The 1-year survival was estimated for both treatment groups by using Kaplan-Meier survival method. Results: A total of 5,844 patients with SAH were treated with either endovascular (n = 2,843, 48.6%) or surgical treatment (n = 3000, 51.4%).The rate of all-cause in-hospital mortality (10.2% vs 12.1%, P = 0.1895) was similar among patients treated with surgical or endovascular treatment. The estimated 1-year recurrent intracranial hemorrhage survival was 99.5% and 97.4% in patients who underwent surgical and endovascular treatments, respectively (p= <.0001). After adjusting for age, and All Patient Refined DRGs (APDRG) severity score, the RRs of recurrent any intracranial hemorrhage was higher with endovascular treatment (RR, 6.0; 95% confidence interval (CI), 2.3 -15.7 p= 0.0002). The rates of SAH (RR, 6.1; 95% CI, 2.1 -17.9 p= <.0001) was significantly higher and a trend was observed for higher rate ofintracerebral hemorrhage (RR, 6.2; 95% confidence interval, 0.7 -52.5 p=0.0940) among patients treated with endovascular modality. . Conclusion: Although the rates of recurrent intracranial hemorrhage related hospitalization were low among patients with ruptured intracranial aneurysms, there was a higher rate among patients treated with endovascular treatment.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

Abstract WP164: National Estimates of Recurrent Ischemic Stroke Among Patients Undergoing Carotid Revascularization: Effect of Treatment Modality

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Yun Fang ◽  
Ameer E Hassan ◽  
Iqra N Akhtar ◽  
Mohammad Rauf A Chaudhry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Proportional Hazards ◽  
Carotid Stenting ◽  
Cox Proportional Hazards ◽  
Carotid Revascularization ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Hospitalization Period ◽  
Nationally Representative

Background: The estimates of recurrent ischemic stroke in the post-hospitalization period among patients treated for carotid revascularization are not available outside clinical trials (real-world settings). Objective: To determine the rates of ischemic stroke-related hospitalization within 3 months post-hospitalization for treatment of carotid stenosis in a nationwide cohort. Methods: We identified all readmissions related to new ischemic stroke in the nationally representative data for all patients hospitalized for carotid revascularization using the Nationwide Readmissions Database (NRD) 2013 and 2014 for carotid stent placement (CAS) and carotid endarterectomy (CEA). Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent ischemic stroke for patients in treatment cohorts after adjusting for potential confounders. The survival was estimated for both treatment groups by using Kaplan-Meier survival method. Results: A total of 120, 923patients with carotid stenosis were treated with either CAS (n = 15, 819; 13.1%) or CEA (n = 105,103; 86.9%).- The estimated 3 month recurrent ischemic stroke free survival was 99.2% and 98.9% in patients who underwent CEA and CAS treatments, respectively (p= 0.014). After adjusting for age, and APDRG severity score, the RRs of recurrent any ischemic stroke was higher women (RR, 1.3; 95% confidence interval (CI), 1.1 -1.6), symptomatic patients (RR, 1.5; 95% CI, 1.1 -2.1) and weekend admission (RR, 1.6; 95% CI, 1.1 -2.3). Conclusion: Although the rates of recurrent ischemic stroke-related hospitalization were low among patients undergoing carotid revascularization, there were higher rates among women, symptomatic patients, undergoing carotid stenting and those admitted on weekends.

Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

2015 ◽  
Vol 8 (11) ◽  
pp. 1148-1153 ◽  
Author(s):  
Xiao-dong Liang ◽  
Zi-liang Wang ◽  
Tian-xiao Li ◽  
Ying-kun He ◽  
Wei-xing Bai ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Thromboembolic Events ◽  
Maintenance Infusion ◽  
Safety And Efficacy ◽  
Fatal Hemorrhage ◽  
Ruptured Intracranial Aneurysms

BackgroundCoil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.ObjectiveTo determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.MethodsTirofiban was administered as an intravenous bolus (8.0 μg/kg over 3 min) followed by a maintenance infusion (0.10 μg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2 h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.ResultsTirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found.ConclusionsTirofiban bolus over 3 min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.

scholarly journals Prevalence of thunderclap headache in patients with ruptured intracranial aneurysms: series of 60 cases

2019 ◽  
pp. 189-192
Author(s):  
Bruno Bertoli Esmanhotto ◽  
Elcio Juliato Piovesan ◽  
Marcos Christiano Lange
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Thunderclap Headache ◽  
Head Pain ◽  
Ruptured Intracranial Aneurysm ◽  
One Year ◽  
Time Of Admission ◽  
Ruptured Intracranial Aneurysms

Thunderclap headache (TCH) is a head pain that begins suddenly and is severe at onset. TCH might be the first sign of subarachnoid hemorrhage. This study was conducted to evaluate the presence of thunderclap headache (TCH) in patients with ruptured intracranial aneurysm (RIA) and endovascular treatment (EVT). We evaluated the pattern of headache in 60 patients who suffered a RIA and EVT at time of admission and prospectively evaluated the characteristics of previous headache within one year before the rupture. Thirty-one patients (51,7 %) had TCH related to the rupture. Aneurysm size does not affect the occurrence of thunderclap headache (p=0,08). The vascular aneurysm territory is not related to presence of TCH (p=0,527). The prevalence of TCH in this cohort was similar to previous studies. All patients with acute thunderclap headache should be evaluated for subarachnoid hemorrhage.

Abstract 111: Comparison of Long-term Outcomes Associated with Endovascular Treatment Versus Surgical Treatment Among Medicare Beneficiaries with Unruptured Intracranial Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Saqib A Chaudhry ◽  
Wondwossen G Tekle ◽  
M Fareed K Suri
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Medicare Beneficiaries ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Second Procedure

Objective: To determine the 5 year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. Methods: The study included a representative sample of fee-for-service Medicare beneficiaries aged 65 years or older who underwent endovascular or surgical treatment for unruptured intracranial aneurysms between 1999 through 2010. The Medicare Provider Analysis and Review files were linked to the Center for Medicaid and Medicare Services denominator files for 2000-2010 to ascertain any new admission or mortality. Cox proportional hazards and Kaplan Meir survival analyses were used to assess the relative risk of all-cause mortality, new intracranial hemorrhage, or second procedure for patients treated with endovascular treatment compared with those treated with surgical treatment after adjusting for potential confounders. Results: A total of 1005 patients with unruptured intracranial aneurysms were treated with either endovascular (n=569) or surgical treatment (n=436) with post-procedure follow-up available for 4.64 (±2.98) years. The rate of immediate post-procedural neurological complications (8.7% vs. 3.2%, p<0.0001) and requirement for intraventricular catheter (2.8% vs. 0.7%, p=0.019) was higher among patients treated with surgery compared with those treated with endovascular treatment. The estimated 5 year survival was 93.6% and 95.8% in patients treated with surgical and endovascular treatments, respectively. After adjusting for age, gender, and race/ethnicity, relative risks of all-cause mortality (RR 0.5, 95% CI 0.3-0.9) and new intracranial hemorrhage (RR 0.4, 95% CI 0.2-0.8) were significantly lower with endovascular treatment. Conclusions: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events, long-term all-cause mortality and new intracranial hemorrhages.

scholarly journals Evaluation of clinical and anatomical outcome of staged stenting after acute coiling of ruptured intracranial aneurysms

2019 ◽  
Vol 26 (3) ◽  
pp. 260-267 ◽  
Author(s):  
Benjamin Mine ◽  
Thomas Bonnet ◽  
Juan Carlos Vazquez-Suarez ◽  
Noémie Ligot ◽  
Boris Lubicz
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Status ◽  
Long Term Stability ◽  
Ruptured Intracranial Aneurysm ◽  
Improved Stability ◽  
Ruptured Intracranial Aneurysms ◽  
Anatomical Outcome

Introduction Stent-assisted coiling has widened indications and improved stability of endovascular treatment of intracranial aneurysms. However, stent-assisted coiling is usually not used to treat acutely ruptured intracranial aneurysms to avoid antiplatelet therapy. The objective of this study is to evaluate a strategy of staged endovascular treatment of ruptured intracranial aneurysms including coiling at the acute phase with complementary stenting with or without coiling at the subacute phase. Material and methods Between 2012 and 2017, we retrospectively identified, in our prospectively maintained database, all patients treated for a ruptured intracranial aneurysm based on this staged stenting strategy. Clinical charts and imaging follow-up were analyzed to assess the procedural safety and feasibility as well as clinical and anatomical outcome. Results We identified 23 patients with 23 intracranial aneurysms including 15 (65.2%) women with a mean age of 50 years (range 24–69 years). No rebleeding occurred during the mean delay of 24.3 days between initial coiling and stenting. All procedures were successful and additional coiling was performed in 5/23 procedures (21.7%). Clinical status was unchanged in all patients. At follow-up, the modified Rankin scale was graded 0 in 19/23 (82.6%), 1 in 2/23 (8.7%), and 2 in 2/23 (8.7%) patients, respectively. The rate of complete occlusion rose from 30.4% before the stenting procedure to 52.2% immediately after and 72.7% at follow-up. Conclusion This strategy of early staged stenting in selected patients is safe and improves immediate intracranial aneurysm occlusion and long-term stability in this population at high risk of intracranial aneurysm recurrence with coiling alone.

scholarly journals Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States

2009 ◽  
Vol 110 (5) ◽  
pp. 880-886 ◽  
Author(s):  
Alberto Maud ◽  
Kamakshi Lakshminarayan ◽  
M. Fareed K. Suri ◽  
Gabriela Vazquez ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Term Care ◽  
Ruptured Intracranial Aneurysm ◽  
Neurosurgical Treatment ◽  
The Cost ◽  
Ruptured Intracranial Aneurysms

Object The results of the International Subarachnoid Aneurysm Trial (ISAT) demonstrated lower rates of death and disability with endovascular treatment (coiling) than with open surgery (clipping) to secure the ruptured intracranial aneurysm. However, cost-effectiveness may not be favorable because of the greater need for follow-up cerebral angiograms and additional follow-up treatment with endovascular methods. In this study, the authors' goal was to compare the cost-effectiveness of endovascular and neurosurgical treatments in patients with ruptured intracranial aneurysms who were eligible to undergo either type of treatment. Methods Clinical data (age, sex, frequency of retreatment, and rebleeding) and quality of life values were obtained from the ISAT. Total cost included those associated with disability, hospitalization, retreatment, and rebleeding. Cost estimates were derived from the Premier Perspective Comparative Database, data from long-term care in stroke patients, and relevant literature. Incremental cost-effectiveness ratios (ICERs) were estimated during a 1-year period. Parametric bootstrapping was used to determine the uncertainty of the estimates. Results The median estimated costs of endovascular and neurosurgical treatments (in US dollars) were $45,493 (95th percentile range $44,693–$46,365) and $41,769 (95th percentile range $41,094–$42,518), respectively. The overall quality-adjusted life years (QALY) in the endovascular group was 0.69, and for the neurosurgical group it was 0.64. The cost per QALY in the endovascular group was $65,424 (95th percentile range $64,178–$66,772), and in the neurosurgical group it was $64,824 (95th percentile range $63,679–$66,086). The median estimated ICER at 1 year for endovascular treatment versus neurosurgical treatment was $72,872 (95th percentile range $50,344–$98,335) per QALY gained. Given that most postprocedure angiograms and additional treatments occurred in the 1st year and the 1-year disability status is unlikely to change in the future, ICER for endovascular treatment will progressively decrease over time. Conclusions Using outcome and economic data obtained in the US at 1 year after the procedure, endovascular treatment is more costly but is associated with better outcomes than the neurosurgical alternative among patients with ruptured intracranial aneurysms who are eligible to undergo either procedure. With accrual of additional years with a better outcome status, the ICER for endovascular coiling would be expected to progressively decrease and eventually reverse.

Comparison of Long-term Outcomes Associated With Endovascular Treatment vs Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (4) ◽  
pp. 380-387 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Saqib A. Chaudhry ◽  
Wondwossen G. Tekle ◽  
M. Fareed K. Suri
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Medicare Beneficiaries ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Second Procedure

Abstract BACKGROUND: Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date. OBJECTIVE: To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. METHODS: The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for unruptured intracranial aneurysms with postprocedure follow-up of 4.7 (±3.0) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality, new intracranial hemorrhage, or second procedure for patients who underwent endovascular treatment compared with those who underwent surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups by using Kaplan-Meier survival methods. RESULTS: A total of 688 patients with unruptured intracranial aneurysms were treated with either endovascular (n = 398) or surgical treatment (n = 290). The rate of immediate postprocedural neurological complications (10.3% vs 3.5%, P = .001) was higher among patients treated with surgery than among those who underwent endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients who underwent surgical and endovascular treatments, respectively. After adjusting for age, sex, and race/ethnicity, the RRs of all-cause mortality (RR, 0.6; 95% confidence interval, 0.3-1.1) and new intracranial hemorrhage (RR, 0.4; 95% confidence interval, 0.2-0.8) were lower with endovascular treatment. CONCLUSION: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.

Impact of International Subarachnoid Aneurysm Trial results on treatment of ruptured intracranial aneurysms in the United States

2011 ◽  
Vol 114 (3) ◽  
pp. 834-841 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Gabriela Vazquez ◽  
Nauman Tariq ◽  
M. Fareed K. Suri ◽  
Kamakshi Lakshminarayan ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Trend Test ◽  
Hospital Outcomes ◽  
Ruptured Intracranial Aneurysm ◽  
International Subarachnoid Aneurysm Trial ◽  
The Cost ◽  
The Impact ◽  
Ruptured Intracranial Aneurysms

Object The utilization of endovascular treatment for ruptured intracranial aneurysms is expected to change since the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. The authors performed this analysis to determine the impact of ISAT results on treatment selection for ruptured intracranial aneurysms and associated in-hospital outcomes using nationally representative data. Methods We determined the national estimates of treatments used for ruptured intracranial aneurysms and associated in-hospital outcomes, length of stay, mortality, and cost incurred using the Nationwide Inpatient Survey (NIS) data. The NIS is the largest all-payer inpatient care database in the US and contains data from 986 hospitals approximating a 20% stratified sample of US hospitals. All the variables pertaining to hospitalization were compared between 2000–2002 and 2004–2006, and in-hospital outcomes were analyzed using multivariate analysis. Results In the 3-year periods prior to and after the ISAT, there were 70,637 and 77,352 admissions for ruptured intracranial aneurysms, respectively. There was a significant increase in endovascular treatment after publication of the ISAT (trend test, p < 0.0001) The in-hospital mortality for ruptured intracranial aneurysm admissions decreased from 27% to 24% (odds ratio [OR] 0.89, 95% CI 0.83–0.96, p = 0.003) after the publication of the ISAT. The cost of hospitalization after adjusting for procedures practices was not significantly higher after the publication of the ISAT ($21,437 vs $22,817, p < 0.89), but cost of hospitalization was higher in the post-ISAT period for patients undergoing endovascular procedure. Conclusions The results of the ISAT have been associated with a prominent change in practice patterns related to the treatment of ruptured aneurysms. The cost of hospitalization has increased and the mortality has decreased, presumably due to a larger proportion of patients receiving any treatment and endovascular treatment.

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