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.