E-052 necessity of icu monitoring following elective endovascular treatment of unruptured intracranial aneurysms

Abstract

Background Overnight stay in the ICU is standard protocol after elective endovascular intracranial aneurysm coiling. Given the low expected complication rate of elective aneurysm embolizations, as well as limited resources and cost of Neuroscience ICU, we wanted to evaluate if transitioning patients to a lower acuity floor bed would be appropriate after PACU recovery following elective coil embolization. Objective Evaluate our elective endovascular intracranial aneurysm treatment database to determine the frequency and timing of complications to determine if patients necessitated an ICU bed. Materials and methods Database of 261 consecutive cases of elective aneurysm coil embolizations with or without stent or balloon assistance dating back to 2012 were reviewed in a retrospective manner. Length of stay, Modified Rankin Score, type of complication, timing of complication, permanency of complication, and imaging follow-up was documented. Statistical analysis to determine rate of complications, and mean time to complication was performed. Results A total of 261 consecutive patients were evaluated having undergone elective treatment of intracrainial aneurysms between 2012 through 2014. Overall complication rate was 12.3%. There were 3 deaths (1.1%), and 18 infarcts (6.9%) which overlapped with 2 of the deaths. Of the patients which had infarcts, 5 were found during the procedure, 7 were two days or greater from the procedure, with 6 patients having an infarct between 2 h and one day (time in ICU). Of the 6 patients having infarcts during the time 2–12 h post-procedure time period, 2 patients left the hospital the next day, no significant intervening treatments were performed on 3 of the patients, and one patient underwent a hemicraniectomy. Intracranial hemorrhage was seen in 6 (2.3%) of the patients, with 5 of the hemorrhages recognized at the time of the procedure, and the 6th hemorrhage at 18 h after the procedure. Clot formation was seen in 5 patients, 4 of which were recognized during the procedure, and the 5th clot formation approximately 6 h after the procedure. Six (2.3%) coil herniations occurred, all of which were discovered during the procedure. Six retroperitoneal hematomas (2.3%) which were all discovered within six hours, 3 of which were discovered before two hours, and 3 of which were between two and six hours. Conclusion Technically successful elective intracranial coil embolization with uneventful post-anesthesia recovery are not felt to require routine ICU admittance due to the low rate of complications encountered during the time patient would be in the ICU. Of the complications encountered during the time patients would be in the ICU, 0.4% of patients underwent treatment for their infarct, and 1.2% of patients were discovered to have retroperitoneal hematomas. Technically difficult cases, additional risk factors, high atherosclerotic burden, or difficult access may predispose a clinician to admit an elective case to the ICU, although a technically uneventful case with an expected post-anesthesia recovery may alleviate the need for routine ICU monitoring. Disclosures J. Gingras: None. A. Evans: None. C. Durst: None. M. Jensen: None. H. Hixson: None. J. Gaughen: None. K. Liu: None. J. Patrie: None.