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Original research
In-hospital outcomes associated with stent-assisted endovascular treatment of unruptured cerebral aneurysms in the USA
  1. Jennifer S McDonald1,
  2. Andrew P Norgan2,
  3. Robert J McDonald1,
  4. Giuseppe Lanzino1,3,
  5. David F Kallmes1,3,
  6. Harry J Cloft1,3
  1. 1Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Medical Scientist Training Program, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Jennifer S McDonald, Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA; mcdonald.jennifer{at}mayo.edu

Abstract

Background Adjunctive stenting has increasingly become an acceptable option for the endovascular treatment of unruptured aneurysms. The Nationwide Inpatient Sample (NIS) was used to compare US in-hospital outcomes related to coiling with and without adjunctive stenting for unruptured aneurysms.

Methods Hospitalizations for coiling of unruptured cerebral aneurysms from 2004 to 2008 were identified in the NIS by extracting ICD-9-CM codes for the diagnosis of unruptured aneurysm (437.3) and intracranial stenting (00.65) with coiling (39.52, 39.79 or 39.72) of cerebral aneurysms. All patients with a diagnosis of subarachnoid hemorrhage (430) and/or intracerebral hemorrhage (431) were excluded. Mortality and discharge to a long-term facility were compared between stent and non-stent patient groups using multivariate regression analysis.

Results Patients treated with stent-assisted coiling had an in-hospital mortality rate of 0.08–0.8% compared with a death rate of 0.5% (95% CI 0.3% to 0.7%) for patients who did not receive a stent during coiling (p=0.36). Patients in the stent group had a 3% rate of discharge to a care facility (95% CI 1.5% to 5.8%) compared with 5% (95% CI 4.5% to 5.6%) for those in the non-stent group (p=0.14). Patients treated with a stent had a similar likelihood of in-hospital mortality (adjusted OR, 2.12 (95% CI 0.32 to 7.11), p=0.34) and a lower likelihood of discharge to a long-term care facility (adjusted OR 0.59 (95% CI 0.24 to 1.16), p=0.16) compared with the non-stent group.

Conclusions Adjunctive stenting adds little in-hospital risk to the endovascular treatment of cerebral aneurysms. However, the need for dual antiplatelet therapy may predispose to delayed hemorrhagic complications and discontinuation of dual antiplatelet therapy may lead to delayed thromboembolic complications.

  • Stent
  • cerebral aneurysm
  • endovascular procedures
  • outcome assessment

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Footnotes

  • Competing interests JSM receives an investigator-initiated research grant from General Electric Healthcare. HJC is the site PI of a registry study for Cordis Endovascular. GL receives an educational grant from EV3 and gives expert testimony in relation to EV3/Coviden. DFK is a RSNA deputy editor. These disclosures are unrelated to the current study. RJM and APN have no competing interests.

  • Ethics approval This study used the Nationwide Inpatient Sample, a de-identified patient database. Therefore, this study did not require IRB review in accordance with the Code of Federal Regulations, 45 CFR 46.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data were generated from the Nationwide Inpatient Sample, a publically-available database.

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