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Original research
Endovascular coiling versus neurosurgical clipping for treatment of ruptured and unruptured intracranial aneurysms during pregnancy and postpartum period
  1. Aayushi Garg1,
  2. Amjad Elmashala1,
  3. Hannah Roeder1,
  4. Santiago Ortega-Gutierrez2
  1. 1Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Departments of Neurology, Neurosurgery, and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Aayushi Garg, Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52241, USA; aayushigarg18{at}gmail.com

Abstract

Background Selection of appropriate surgical strategy for the treatment of intracranial aneurysms (IA) during pregnancy requires careful consideration of the potential risks to the mother and fetus. However, limited data guide treatment decisions in these patients. We compared the safety profiles of endovascular coiling (EC) and neurosurgical clipping (NC) performed for the treatment of ruptured and unruptured IA during pregnancy and the postpartum period.

Methods Pregnancy-related or postpartum hospitalizations undergoing surgical intervention for IA were identified from the Nationwide Readmissions Database 2016–2018. Safety outcomes included periprocedural complications, in-hospital mortality, discharge disposition, and 30-day non-elective readmissions.

Results There were 348 pregnancy-related or postpartum hospitalizations that met the study inclusion criteria (mean±SD age 31.8±5.9 years). Among 168 patients treated for ruptured aneurysms, 115 (68.5%) underwent EC and 53 (31.5%) underwent NC; whereas among 180 patients treated for unruptured aneurysms, 140 (77.8%) underwent EC and 40 (22.2%) underwent NC. There were no statistically significant differences in the baseline characteristics between patients undergoing EC versus NC for either ruptured or unruptured aneurysm groups. The outcomes were statistically comparable between EC and NC for both ruptured and unruptured IA, except for a lower incidence of ischemic stroke in patients undergoing EC for ruptured aneurysms (OR 0.12, 95% CI 0.02 to 0.84).

Conclusions Most pregnant and postpartum patients are treated with EC for both ruptured and unruptured IA. For treatment of ruptured IA, EC is independently associated with a lower risk of perioperative ischemic stroke, but other in-hospital complications and mortality are comparable between EC and NC.

  • Aneurysm
  • Coil
  • Hemorrhage
  • Intervention
  • Subarachnoid

Data availability statement

Data are available in a public, open access repository. Data in this study were obtained from the Nationwide Readmissions Database, which is a publicly available database and can be obtained after completing the HCUP data use agreement.

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Data availability statement

Data are available in a public, open access repository. Data in this study were obtained from the Nationwide Readmissions Database, which is a publicly available database and can be obtained after completing the HCUP data use agreement.

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Footnotes

  • AG and AE contributed equally.

  • Contributors AG was involved in study concept/design, statistical analysis, drafting, revision of the manuscript and is responsible for the overall content. AE was involved in the interpretation of data and drafting of the manuscript. HR was involved in drafting and critical revision of the manuscript. SO-G was involved in study concept/design and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Santiago Ortega-Gutierrez receives grant funding from NIH, Stryker, medtronic and VizAi. He is consultant for Medtronic, Stryker and Microvention.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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