E-182 Comparing outcomes of open and endovascular treatment of ruptured middle cerebral artery aneurysms: insights from a national level inpatient database Article Swipe
Cody Heskett
,
L Fry
,
G LeBeau
,
Fabio De Stefano
,
A Brake
,
Chunlin Lei
,
K Le
,
Abdul-Rahman Alkiswani
,
Jeremy Peterson
,
Koji Ebersole
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1136/jnis-2023-snis.281
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1136/jnis-2023-snis.281
Background Optimal therapeutic strategy for the management of ruptured MCA aneurysms remains highly controversial. Microsurgical clipping and endovascular therapies are two primary strategies utilized in acute management with prior studies showing certain advantages to both. As such, robust studies comparing the two are lacking in the literature. As the treatment paradigm for the management of all ruptured intracranial aneurysms progresses, specific consideration for the management of ruptured MCA aneurysms is needed. Here we utilize a national level database, comparing in-hospital outcomes between endovascular and microsurgical treatment of ruptured MCA aneurysms. Methods Weighted discharge NIS data from 2016-2020 was surveyed for patients admitted with primary International Classification of Disease version 10 (ICD-10) diagnosis of ruptured aneurysm of the middle cerebral artery (MCA). The primary outcome measure was the NIS Subarachnoid Outcome Measurement (NIS-SOM), a dichotomous variable signifying a poor outcome when present. A positive NIS-SOM is derived from discharge to skilled-nursing, hospice, inpatient mortality, gastrostomy tube placement, or tracheostomy placement. The NIS-SOM, when present, has been shown to have a strong correlation with a modified Rankin Score (mRS) >3. Further, we compared lengths of stay, rates of primary treatment strategy, gender, age, vasospasm, and treatment of vasospasm. Results 6525 total patients were analyzed. 3135 received endovascular treatment while 3390 underwent surgical clipping. There were no differences in age, gender, or inpatient mortality rates between the groups. Rates of vasospasm were not significantly different between treatment groups. However, patients undergoing surgical clipping were more likely to receive treatment for vasospasm when present. Length of stay was significantly lower among those treated endovascularly (18.6 days vs. 20.1 days, p = 0.05). Patients who underwent open surgical clipping, while not significant, tended to have higher proportions of poor outcomes, as determined by NIS-SOM (71.53.% vs. 67.62%, p = 0.125). Conclusion In this analysis of a national level database, we demonstrate that endovascular therapy trends towards having higher rates of favorable outcomes when compared to treatment with open surgical clipping. Patients treated by endovascular therapies also experience shorter lengths of inpatient stay. Despite this, inpatient mortality rates between treatment groups are similar. Non-elective SAH patients with aneurysm of MCA. Treated with Endo vs Surgery. NIS_SOM being positive means a bad outcome (Discharge to SNF, LTACH, Died, Got Trached or G-tube). Disclosures C. Heskett: None. L. Fry: None. G. LeBeau: None. F. De Stefano: None. A. Brake: None. C. Lei: None. K. Le: None. A. Alkiswani: None. J. Peterson: None. K. Ebersole: None.
Related Topics
Concepts
Medicine
Clipping (morphology)
Middle cerebral artery
Endovascular coiling
Subarachnoid hemorrhage
Endovascular treatment
Aneurysm
Vasospasm
Neurointensive care
Mortality rate
Modified Rankin Scale
Surgery
Anesthesia
Internal medicine
Philosophy
Ischemia
Linguistics
Ischemic stroke
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/jnis-2023-snis.281
- https://jnis.bmj.com/content/neurintsurg/15/Suppl_1/A185.1.full.pdf
- OA Status
- gold
- References
- 1
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4385398263
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4385398263Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1136/jnis-2023-snis.281Digital Object Identifier
- Title
-
E-182 Comparing outcomes of open and endovascular treatment of ruptured middle cerebral artery aneurysms: insights from a national level inpatient databaseWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-07-01Full publication date if available
- Authors
-
Cody Heskett, L Fry, G LeBeau, Fabio De Stefano, A Brake, Chunlin Lei, K Le, Abdul-Rahman Alkiswani, Jeremy Peterson, Koji EbersoleList of authors in order
- Landing page
-
https://doi.org/10.1136/jnis-2023-snis.281Publisher landing page
- PDF URL
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https://jnis.bmj.com/content/neurintsurg/15/Suppl_1/A185.1.full.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://jnis.bmj.com/content/neurintsurg/15/Suppl_1/A185.1.full.pdfDirect OA link when available
- Concepts
-
Medicine, Clipping (morphology), Middle cerebral artery, Endovascular coiling, Subarachnoid hemorrhage, Endovascular treatment, Aneurysm, Vasospasm, Neurointensive care, Mortality rate, Modified Rankin Scale, Surgery, Anesthesia, Internal medicine, Philosophy, Ischemia, Linguistics, Ischemic strokeTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- References (count)
-
1Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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