Abstract 1122‐000053: Trends in Intervention Modality for Patients with Mycotic Aneurysms: A Nationwide Analysis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Giana Dawod ◽  
Giana Dawod ◽  
Cenai Zhang ◽  
Hang Shi ◽  
Alexander E Merkler ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Sample Survey ◽  
Treatment Modalities ◽  
National Inpatient Sample ◽  
Mycotic Aneurysms ◽  
Over Time ◽  
Infectious Intracranial Aneurysms

Introduction : Mycotic aneurysms, also known as infectious intracranial aneurysms, are sometimes responsible for intracranial hemorrhage in patients with infective endocarditis. Data regarding when and how to treat mycotic aneurysms most effectively are sparse. Given the widespread adoption of endovascular treatments for non‐infectious intracranial aneurysms and acute stroke, we hypothesized that endovascular treatment is increasingly utilized for patients with mycotic aneurysms. We examined trends in endovascular versus open neurosurgical treatment of mycotic aneurysms in patients with infective endocarditis. Methods : We performed a trends analysis using data from 2000–2015 from the National Inpatient Sample. The National Inpatient Sample is an all‐payer database that includes data for a representative sample of hospitalizations to non‐federal hospitals in the United States. We included all hospitalizations for patients with ruptured (on the basis of subarachnoid hemorrhage) or unruptured cerebral aneurysms alongside a diagnosis of infective endocarditis; diagnoses were ascertained using ICD‐9‐CM codes. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD‐9‐CM procedure codes. National Inpatient Sample survey weights were used to calculate nationally representative estimates. Logistic regression was used to evaluate the association between calendar year and intervention rate, presented as an odds ratio for each additional year. Results : We identified 1,015 hospitalizations for patients with a ruptured or unruptured cerebral aneurysm in the setting of infective endocarditis. Their mean age was 54.6 years (SD, 16.6), and 60.1% were male. The overall rate of intervention was 11.9% (95% CI, 9.6‐14.2%), and this rate did not change appreciably over time (p = 0.772). In comparing intervention modalities over time, there was a decrease in open neurosurgical repair (OR, 0.89; 95% CI, 0.84‐0.95; p = 0.001), offset by an increase in endovascular repair (OR, 1.07; 95% CI, 1.01‐1.14; p = 0.023) (Figure). Conclusions : Rates of mycotic aneurysm intervention during hospitalizations for infective endocarditis have not changed. However, the use of endovascular treatment has become more commonplace while the use of open neurosurgical treatments has decreased. Further directions include understanding whether this shift has improved patients’ outcomes and ultimately enumerating best practices for patients with mycotic aneurysms.

scholarly journals Ruptured Intracranial Mycotic Aneurysm in Infective Endocarditis: A Natural History

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Isabel Kuo ◽  
Theodore Long ◽  
Nathan Nguyen ◽  
Bharat Chaudry ◽  
Michael Karp ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Natural History ◽  
Intracranial Aneurysms ◽  
Mycotic Aneurysm ◽  
Treatment Modalities ◽  
Intraparenchymal Hemorrhage ◽  
Retrospective Case ◽  
Aneurysm Clipping ◽  
History Of ◽  
Mycotic Aneurysms

Mycotic aneurysms are a rare cause of intracranial aneurysms that develop in the presence of infections such as infective endocarditis. They account for a small percentage of all intracranial aneurysms and carry a high-mortality rate when ruptured. The authors report a case of a 54-year-old man who presented with infective endocarditis of the mitral valve and acute stroke. He subsequently developed subarachnoid hemorrhage during antibiotic treatment, and a large intracranial aneurysm was discovered on CT Angiography. His lesion quickly progressed into an intraparenchymal hemorrhage, requiring emergent craniotomy and aneurysm clipping. Current recommendations on the management of intracranial Mycotic Aneurysms are based on few retrospective case studies. The natural history of the patient's ruptured aneurysm is presented, as well as a literature review on the management and available treatment modalities.

Endovascular treatment of infectious intracranial aneurysms complicating infective endocarditis: a series of 31 patients with 55 aneurysms

2021 ◽  
Author(s):  
Fabiola Serrano ◽  
Alexis Guédon ◽  
Jean-Pierre Saint-Maurice ◽  
Marc-Antoine Labeyrie ◽  
Vittorio Civelli ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Infectious Intracranial Aneurysms

scholarly journals Endovascular Management of Infective Intracranial Aneurysms with Acrylic Glue

2009 ◽  
Vol 15 (4) ◽  
pp. 443-447 ◽  
Author(s):  
A. Bhattacharyya ◽  
S. Mittal ◽  
R.R. Yadav ◽  
K. Jain ◽  
B. Gupta ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Endovascular Treatment ◽  
Medical Management ◽  
Intracranial Aneurysms ◽  
Good Prognosis ◽  
Endovascular Management ◽  
Significant Morbidity ◽  
Liquid Embolic ◽  
Mycotic Aneurysms ◽  
Acrylic Glue

Cerebral mycotic aneurysms (MAs) also called infective aneurysms, are uncommon and are usually encountered in patients with infective endocarditis. These aneurysms often present with intracranial hemorrhage. MAs may resolve on treatment with antibiotics alone. However prognosis with medical management alone is unpredictable. Good prognosis with surgery has been reported for single accessible ruptured MAs. However surgery is associated with significant morbidity. Endovascular treatment of MAs along with appropriate antibiotics is emerging as an acceptable option for these patients. We describe two cases of infective endocarditis complicated by ruptured MA treated successfully by liquid embolic glue material.

Abstract 3956: Outcomes of Patients Undergoing Endovascular Treatment for Mycotic Intracranial Aneurysms

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Saqib A Chaudhry ◽  
M Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Multivariate Logistic Regression Analysis ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Hospital Outcomes ◽  
Aneurysm Wall ◽  
Mycotic Aneurysms

Background: Mycotic intracranial aneurysms are rare with primary treatment focusing on underlying infection to reduce the high mortality rates. Treating these aneurysms remains challenging and obliteration procedures without sacrificing the parent artery often fail due to the fusiform and fragile aneurysm wall. Objective: To determine the outcomes associated with endovascular embolization in patients with mycotic intracranial aneurysms using a large nationally representative sample. Methods: We determined the frequency of endovascular and surgical procedures performed in patients with mycotic intracranial aneurysms and associated in-hospital outcomes using data from the Nationwide Inpatient Survey (NIS) data files from 2002 to 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate logistic regression analysis. Results: Of the 1,915 patients admitted with the diagnosis of infected “mycotic” aneurysms, 83 (4.3%) underwent endovascular embolization, and 59 (3.1%) underwent surgical treatment. In mycotic aneurysms treated with endovascular treatment compared to surgical treatment, discharge outcomes were better with higher rates of minimal disability self-care (40% vs. 23.7% p=0.2436), and lower rates of moderate-severe disability (36% vs. 40% p=0.7874), and in-hospital deaths death (22.9 vs. 35.2 p= 0.3608). After adjusting for age, gender, and hospital teaching status, discharge mortality after endovascular treatment was not inferior to surgical treatment (odds ratio [OR] 1.58, 95% confidence interval [CI] 0.14 - 17.9) or those treated medically (OR 0.56, 95% CI 0.132 - 2.36). Conclusion: Endovascular embolization for mycotic intracranial aneurysms provides comparable outcomes to surgical treatment and should be considered whenever feasible when aneurysm obliteration is indicated.

scholarly journals Effect of thrombocytopenia in patients with infective endocarditis: an insight from the National Inpatient Sample database

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Patel ◽  
B Amgai ◽  
S Chakraborty ◽  
A Hajra ◽  
K Ashish ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
P Value ◽  
National Inpatient Sample ◽  
Pronounced Increase ◽  
Propensity Match ◽  
Co Morbidity ◽  
The Difference ◽  
Poor Outcomes

Abstract Introduction Infective endocarditis (IE) is one of the feared diseases in septic patients, and incidences are rising due to the intravenous drug abuse epidemic. Sepsis causes an escalation of the platelet destructions leading to thrombocytopenia (1). Few independent hospital-based studies have proposed increase mortality with thrombocytopenia in patients with IE (2–5). We aim to evaluate the significance of thrombocytopenia in IE subjects from the national inpatient sample (NIS) database. Method We analyzed the NIS database from Jan-2016 to Dec-2018 using Stata 16.0. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays per year. We identified patients with IE with or without thrombocytopenia using ICD-10 codes. The primary outcome of interest was in-hospital mortality comparison. We adjusted potential confounders (age, sex, diabetes, hypertension, etc.) with multivariate logistic regression analysis. Further analysis was done after balancing the population co-morbidity using a Greedy propensity match for accuracy. Results A total of 174,495 subjects were included in this study with a diagnosis of IE. Among these individuals, 33,285 patients had a concurrent diagnosis of thrombocytopenia. The mean ages were 53±19.5 years for the thrombocytopenia group and 55±19.8 years for others. Females were equally represented in both cohorts. There were 4,945 (14.86%) vs 2,835 (2.01%) mortalities reported in with and without thrombocytopenia group respectively. After propensity matching, there was a pronounced increase in mortality [Odds ratio (OR): 1.93 (1.72 – 2.15), p-value: <0.001] in the group with thrombocytopenia comparing to others. Complications such as Major bleeding requiring blood transfusion [OR: 1.45 (1.35–1.57)], acute myocardial infarction [OR: 1.56 (1.35–1.70)], complete heart block [OR: 1.44 (1.16–1.53)], cardiac arrest [OR: 1.44 (1.25–1.72)], acute respiratory failure [OR: 1.51 (1.39–1.73)] and pressor support requirement [(OR: 1.73 (1.57–2.01)] were notably higher in the cohort of thrombocytopenia with statistically significant p-value (<0.001). The difference in length of stay between both cohorts after propensity match wasn't statistically significant. Conclusion In conclusion, IE patients with thrombocytopenia have higher incidences of in-patient mortality and poor outcomes than cohort without thrombocytopenia. Some of the adverse consequences could be temporally explained by complications related to underlying thrombocytopenia. Further investigations are needed to delineate the outcome in this group of subjects. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Volumes, outcomes, and complications after surgical versus endovascular treatment of aneurysms in the United States (1993–2015): continued evolution versus steady-state after more than 2 decades of practice

2020 ◽  
pp. 1-14 ◽  
Author(s):  
Pedram Golnari ◽  
Pouya Nazari ◽  
Roxanna M. Garcia ◽  
Hannah Weiss ◽  
Ali Shaibani ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Fold Increase ◽  
The United States ◽  
Diagnosis And Treatment ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
The Past ◽  
The Us ◽  
Risk Ratios ◽  
Over Time

OBJECTIVEAdoption of endovascular treatment (EVT) and other advances in aneurysm care have shifted practice patterns of cerebral aneurysm treatment over the past 2 decades in the US. The objective of this study was to determine whether resulting trends in volumes, outcomes, and complications have matured in general practice or continue to evolve.METHODSData were obtained from the National Inpatient Sample from 1993 to 2015. ICD-9 codes were used to estimate annual volumes, outcomes, and complications following treatment of ruptured and unruptured aneurysms. Univariate and multivariate analyses were used to estimate risk ratios for complications and outcomes. Trends in time were assessed utilizing annual percentage change (APC).RESULTSThe authors found a nearly 5-fold increase in annual admissions with diagnoses of unruptured aneurysms, whereas SAH volume increased less than 50%. Clipping ruptured aneurysms steadily declined (APC −0.86%, p = 0.69 until 1999, then −6.22%, p < 0.001 thereafter), whereas clipping unruptured aneurysms slightly increased (APC 2.02%, p < 0.001). EVT tripled in 2002–2004 and steadily increased thereafter (APC 7.22%, p < 0.001 and 5.85%, p = 0.01 for unruptured and ruptured aneurysms, respectively). Despite a 3-fold increase in both diagnosis and treatment of unruptured aneurysms, the incidence of SAH remained steady at 12 per 100,000 persons per year (APC 0.04%, p = 0.83). In contrast, SAH severity increased over time, as did patient age and comorbidities (all p < 0.001). SAH led to nonroutine discharge more frequently over time after both EVT and clipping (APC 1.24% and 1.10%, respectively), although mortality decreased during the same time (APC −2.48% and −1.44%, respectively). Complications were more frequent after clipping than EVT, but this differential risk diminished during the study period and was less perceptible in ruptured aneurysms. The proportion of patients discharged home after treatment of unruptured aneurysms was significantly lower (p < 0.001) after clipping (69.3%–79.5%) than EVT (88.3%–93.3%); both proportions changed minimally since 1998 (APC −0.39%, p = 0.02, and APC −0.11%, p = 0.14, respectively).CONCLUSIONSEVT volume markedly increased for ruptured and unruptured aneurysms from 1993 to 2015, whereas clipping decreased for ruptured and slightly increased for unruptured aneurysms. The incidence of SAH remained unchanged despite increased diagnosis and treatment of unruptured aneurysms. In ruptured aneurysms, SAH severity has increased over time, as have age, comorbidities, and nonroutine discharges. In contrast, routine discharge after treatment of unruptured aneurysms remains largely unchanged since 1998 and remains lower with clipping.

Abstract WP41: Age-Specific Differences in the Use of Endovascular Treatment and Hospital Outcomes in Patients With Acute Ischemic Stroke: A Community-Wide Perspective

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
International Classification Of Diseases ◽  
The United States ◽  
Primary Diagnosis ◽  
Limited Information ◽  
Hospital Outcomes ◽  
The Impact ◽  
Over Time

Background: Relatively limited information is available about trends over time in the use of endovascular treatment in patients of different ages hospitalized with acute ischemic stroke and the association between use of thrombectomy treatment and hospital outcomes in age strata. We performed this analysis to evaluate trends in the utilization of endovascular treatment in acute ischemic stroke by age strata in real-world practice. Methods: We conducted this study by identifying patients admitted with a primary diagnosis of ischemic stroke in the United States from 2007 to 2016 using the Nationwide Inpatient Sample. International Classification of Diseases, ninth revision, and tenth, Clinical Modification (ICD-9-CM, ICD-10-CM) codes were used to identify patients admitted for ischemic stroke and undergoing endovascular treatment. Results: Of the 4,590,533 patients admitted with ischemic stroke, 269,922 (5.88%) received intravenous thrombolytic treatment, and 51,375 (1.12%) underwent endovascular treatment. There is almost 12-fold significant increase in the use of endovascular treatment patients admitted with acute ischemic stroke between 2007 to 2016. Patients who were 75 years and older experienced a marked increase in the receipt of endovascular treatment over time (0.12% 2007; 1.91% 2016; trend p<0.0001). We observed statistically significant improvement in outcomes including minimal disability (6.3% to 18.8%; trend p<0.0001) and in hospital mortality (25.0% to 16.5%; trend p<0.0001) in patients 75 years and older treated with endovascular treatment in study period. We observed similar trend of outcomes in each of the other age-specific groups under study (<55, 55-64 and 65-74 years). Conclusions: Our findings indicate a recent increase in the use of endovascular in middle-aged and elderly patients with acute ischemic strokes. The impact of endovascular treatment on hospital outcomes was observed in each of our age strata understudy though the magnitude of absolute and relative benefit varied according to age.

scholarly journals Hospitalization at the End of Life in Myeloma Patients: Lessons from the National Inpatient Sample

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Saqib Abbasi ◽  
Brian McClune ◽  
Al-Ola Abdallah ◽  
Leyla Shune ◽  
Ghulam Rehman Mohyuddin
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Cost Of Care ◽  
Infection Frequency ◽  
National Inpatient Sample ◽  
Time Period ◽  
Transfusion Requirements ◽  
Over Time

INTRODUCTION: Multiple myeloma (MM) remains a largely incurable disease, and despite the variety of treatment options available, duration of response decreases with each subsequent line of therapy resulting in refractory disease . In this setting, studies have shown most patients prefer to die in the comfort of home, yet hospitalizations remain frequent at the end of life. We explored the hospitalization burden of MM patients at the end of their life using the National Inpatient Sample (NIS). METHODS: The NIS is a database that provides information on all inpatient hospitalizations in the United States (US), including primary and secondary diagnoses, procedures, length of stay, and disposition. Approximately 20% of admissions are tracked and weighted estimates are provided regarding the total number of hospitalizations. Using the NIS, we tracked hospital admissions for MM patients and inpatient mortality from 2002 to 2014 via procedural International Classification of Disease (ICD) 9 codes to gain insight into trends in transfusions, infectious complications, and cost of admission. Linear regression modeling was used for analysis. Overall annual number of deaths for MM in the United States was obtained from publicly available reports from the Centers for Disease Control (CDC) and Prevention and the National Cancer Institute (NCI). RESULTS: During the time period 2002-2014, the CDC and NCI reported a total of 144,105 deaths from MM, ranging from 10,913 in 2002 to 12,112 in 2014. The NIS identified a total of 233,932 (non-weighted) hospitalizations for MM during this time period. Amongst these, a total of 14,770 (non-weighted) hospitalizations resulted in death, thus 6.3% of all hospitalizations for myeloma patients resulted in death. A weighted sample of 69,825 hospitalizations resulting in deaths were identified. During our study time period, 48.4% of all deaths related to myeloma in the United States occurred in the hospital, ranging from 5,893 (54%) in 2002 to 5,035 (41.6%) in 2014, p&lt;0.01. We analyzed blood transfusion dependency in the hospitalization leading to death. There was a receipt of blood transfusions (35.8%) in 5,285 of the 14,770 (non-weighted) admissions leading to death. Infection frequency was identified using the Clinical Classification Software. The Clinical Classifications Software (CCS) is a tool that allows for clustering patient diagnoses and procedures into clinically meaningful categories. A total of 6,644 infections were identified amongst the 14,770 (non-weighted) hospitalizations leading to death (45.0%). We then analyzed palliative care/hospice involvement during the hospitalization leading to death over time. Palliative care/hospice was consulted in 67 of the 1260 (non-weighted) hospitalizations in 2002 (5.3%), and 338 out of the 1007 (non-weighted) hospitalizations in 2014 (33.57%), p&lt;0.01. Median cost of the hospitalization leading to death increased over time from $48,709 in 2002 to $104,115 in 2014, p&lt;0.01. CONCLUSIONS: Despite a decrease in the percentage of inpatient deaths over time, greater than 40% of patients with myeloma continue to die in the hospital, with significant transfusion requirements and infections at the end of life. This comes with an increased cost to the health care system. Our analysis suggests that while palliative care involvement at the end of life has also increased over time, earlier involvement of palliative care and incorporation of transfusion support within hospice services may decrease the number of myeloma patients dying in the hospital and, therefore, the overall burden and cost of care. Disclosures No relevant conflicts of interest to declare.

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