Mortality rates after treatment of unruptured intracranial aneurysms have substantially decreased in the past decade, according to new findings presented at the Society of NeuroInterventional Surgery’s (SNIS) 17th Annual Meeting (4–7 August; virtual meeting).
The study sought to investigate trends in mortality and morbidity after treatment of unruptured intracranial aneurysms in the USA between 2006 and 2019. Led by Shahram Majidi, assistant professor of Neurosurgery, Neurology and Radiology at Icahn School of Medicine at Mount Sinai Hospital and director of Cerebrovascular Services at Mount Sinai Brooklyn, the team analysed data from 21,609 patients from the Nationwide Inpatient Sample (NIS) database across a 10-year period.
The research compares two treatments for unruptured intracranial aneurysms: microsurgical clipping and endovascular embolisation. Majidi explained to the online viewers that microsurgical clipping involves an open brain surgery, whereas endovascular embolisation is a minimally invasive procedure.
According to Majidi, patients who underwent endovascular embolisation had a significantly higher rate of favourable clinical outcome—defined as discharge to home or acute rehabilitation facility—compared to microsurgical clipping group (91% vs. 74%) and an average of three days shorter hospital stay. “The utilisation of endovascular embolisation has increased in the past decade,” he highlighted.
“Our research indicates that treatment of unruptured brain aneurysm has become exceedingly safer over the last 10 years due to advancement in both microsurgical techniques and endovascular technology,” Majidi maintained. “While overall clinical outcomes have been significantly improved, we found a higher rate of favourable hospital outcome and lower mortality rate among endovascularly treated patients compared to microsurgical clipping.”
The research also found that the overall rate of in-hospital mortality decreased from 0.9% in 2006 to 0.2% in 2016. Overall, 83% of the patients had favourable clinical outcomes. Other independent predictors of in-hospital mortality included advanced age (80 years old and older) and the presence of multiple comorbidities. Moreover, women and African Americans had a lower chance of favourable clinical outcomes independent to the treatment modality.
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