Abstract
Background: Ischemic stroke among hospitalized patients who underwent surgical or endovascular therapies for unruptured intracranial aneurysms (IAs) has not been previously examined in nationally representative samples.Objectives: The purpose of this study is to compare the occurrence and in-hospital outcomes (nonroutine discharge, length of stay) of perioperative ischemic stroke among hospitalized patients diagnosed with unruptured IA across treatment selection [surgical clipping, endovascular coiling, stent- or balloon-assisted coiling (SAC or BAC), combined clipping and coiling].Methods: A cross-sectional study was conducted using 23,053 hospital discharge records from the 2002-2012 Nationwide Inpatient Sample (NIS). Rates, β coefficients, and odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated accounting for survey design complexity, patient- and hospital-level confounders.Results: Ischemic stroke rate was 6.9% [surgical clipping (4.3%), endovascular coiling (8.1%), BAC or SAC (1.9%), and combined techniques (4.2%)]. Multivariable logistic regression models suggested that compared to patients undergoing surgical clipping alone, those undergoing SAC or BAC were less likely to be diagnosed with ischemic stroke (adjusted OR=0.34, 95% CI: 0.14, 0.85). Compared to clipping, endovascular techniques resulted in fewer nonroutine dispositions and shorter hospitalizations, whereas combined techniques resulted in longer hospitalizations. Differences in hospitalization outcomes between treatment types were only affected by ischemic stroke when comparing coiling to clipping.Conclusions: Perioperative ischemic stroke rate among patients with unruptured IA may be less among those undergoing SAC or BAC as compared to those undergoing surgical clipping alone. Improved in-hospital outcomes among coiling versus clipping recipients may depend on ischemic stroke diagnosis.
Highlights
Stroke is a leading cause of disability resulting from aphasia, hemiparesis, depression, rehabilitation, longterm care, and dependence on individuals and assisted devices [1,2], with considerable healthcare expenditures linked to this chronic condition [1, 3]
Perioperative ischemic stroke rate among patients with unruptured intracranial aneurysms (IAs) may be less among those undergoing SAC or BAC as compared to those undergoing surgical clipping alone
Improved in-hospital outcomes among coiling versus clipping recipients may depend on ischemic stroke diagnosis
Summary
Stroke is a leading cause of disability resulting from aphasia, hemiparesis, depression, rehabilitation, longterm care, and dependence on individuals and assisted devices [1,2], with considerable healthcare expenditures linked to this chronic condition [1, 3]. Intracranial aneurysm (IA) rupture is a common SAH etiologic factor [4] and IA rupture is among the leading causes of stroke-related morbidity and mortality in the United States [6]. Two established therapies for patients presenting with an IA include surgical clipping [7] and endovascular coiling [7,8]. Both therapies are aimed at excluding the aneurysm from the intracranial circulation without occluding normal vessels [9]. Ischemic stroke among hospitalized patients who underwent surgical or endovascular therapies for unruptured intracranial aneurysms (IAs) has not been previously examined in nationally representative samples
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