Recent Trends in Electively Treated Unruptured Intracranial Aneurysms

J Stroke Cerebrovasc Dis. 2019 Jul;28(7):2011-2017. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.010. Epub 2019 Apr 12.


Background and purpose: To determine recent treatment and outcome trends in patients undergoing elective surgical clipping (SC) or endovascular therapy (EVT) for unruptured intracranial aneurysms (UIAs) in the United States.

Methods: Data were extracted and analyzed from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality for all patients admitted for elective EVT or SC of UIAs between 2011 and 2014. Treatment trends, in-hospital mortality, complication rates, length of stay (LOS) and total hospital costs were evaluated and analyzed.

Results: A total of 31,070 patients with UIAs were included in our analysis, of which 14,411 and 16,659 underwent elective SC and EVT, respectively. There was no significant difference in in-hospital mortality rates between the 2 groups. EVT was associated with lower in-hospital complication rates, decreased median LOS (.8 days versus 3.3 days, P ≤ .0001), and an increased likelihood of discharge to home (92.9% versus 72.9%, P = .0001). Median total hospital charges were similar in both treatment cohorts. Independent predictors of mortality in the elective population were age over 40 years (P ≤ .0001), weekend treatment (P ≤ .0001), and high co-morbidity status (P ≤ .0001).

Conclusions: In-hospital mortality rates were similar in elective EVT and SC UIA patients; however, EVT was associated with lower in-hospital complication rates and shorter LOS.

Keywords: Intracranial aneurysm; clipping; coiling; endovascular therapy; unruptured.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Elective Surgical Procedures / trends
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / economics
  • Endovascular Procedures / mortality
  • Endovascular Procedures / trends*
  • Female
  • Hospital Costs / trends
  • Hospital Mortality / trends
  • Humans
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / economics
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / surgery*
  • Length of Stay / trends
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / economics
  • Neurosurgical Procedures / mortality
  • Neurosurgical Procedures / trends*
  • Outcome and Process Assessment, Health Care / economics
  • Outcome and Process Assessment, Health Care / trends*
  • Postoperative Complications / mortality
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States