Lifetime Effects of Small Unruptured Intracranial Aneurysms

Aishima, Kaoru; Shimizu, Tatsuya; Aihara, Masanori; Yoshimoto, Yuhei

doi:10.1016/j.wneu.2016.08.060

Cited by 16 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7,8 The size and location contributes to risk of aneurysm rupture, yet the probability of rupture will vary according to its natural history, with other comorbidities of the elderly more likely to cause death. 1,32 We agree with Aishima et al 1 in that long-term risks of UIAs in the elderly are challenging to determine on the basis of the existing literature. Overall, there is strong evidence that most UIAs are asymptomatic, with a high percentage of incidental findings.…”

Section: Figsupporting

confidence: 80%

See 1 more Smart Citation

Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping

Silva¹,

Shao²,

Sylvester

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEObservation and neurosurgical intervention for unruptured intracranial aneurysms (UIAs) in the elderly population is rapidly increasing. Cerebral aneurysm coiling (CACo) is favored over cerebral aneurysm clipping (CAC) in elderly patients, yet some elderly individuals still undergo CAC. The cost-effectiveness of treating UIAs requires further exploration. Understanding the effect of intervention on hospital charges and length of stay (LOS) as well as perioperative mortality and complications can further shed light on its economic impact. The purpose of this study was to analyze the cost and perioperative outcomes of UIAs in elderly patients (≥ 65 years of age) after CACo or CAC intervention.METHODSRetrospective cohorts of CACo and CAC admissions were extracted from National (Nationwide) Inpatient Sample data obtained between 2002 and 2013, forming parallel intervention groups to compare the following outcomes between elderly and nonelderly patients: average LOS and mean hospital admission costs, in-hospital mortality, and complications. Covariates included sex, race or ethnicity, and comorbidities.RESULTSElderly patients undergoing CAC experienced an average LOS of 8.0 days, whereas elderly patients undergoing CACo stayed an average of 3.2 days. The mean hospital charges incurred during admission totaled $95,960 in the elderly patients who underwent CAC versus $87,960 in the ones who underwent CACo. Elderly patients in whom CAC was performed had a 2.2% rate of in-hospital mortality, with a 2.6 greater adjusted odds of in-hospital mortality than nonelderly patients treated with CAC. In contrast, elderly patients who underwent CACo had a 1.36 greater adjusted odds of in-hospital mortality than their nonelderly counterparts. Compared to nonelderly patients receiving both interventions, elderly individuals had a significantly higher prevalence of various comorbidities and incidence of complications. Elderly patients who received CAC experienced a 10.3% incidence rate of perioperative stroke, whereas their CACo counterparts experienced this complication at a rate of 3.5%. Elderly patients treated with CAC had greater odds of perioperative acute renal failure, whereas their CACo counterparts had greater odds of perioperative deep venous thrombosis and pulmonary embolism.CONCLUSIONSIntervention with CAC and CACo in the elderly is resource intensive and is associated with higher risk than in the nonelderly. Those deciding between intervention and conservative management should consider these risks and costs, especially the 2.2% postoperative mortality rate associated with CAC in the elderly population. Further comparative cost-effectiveness research is needed to weigh these costs and outcomes against those of conservative management.

show abstract

Section: Figsupporting

confidence: 80%

“…25 Our findings warrant further analysis for consideration of observation as a safe and cost-effective alternative for the elderly subpopulation. 1,2 Backes et al 2 proposed a risk score instrument for intervention or observation of UIAs, to which we encourage further expansion as an economically useful tactic in decision making.…”

Section: Figmentioning

confidence: 95%

Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping

Silva¹,

Shao²,

Sylvester

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…This also applies to UIAs regarding what can cause them to bleed and when. There is a high variability between populations in the prevalence of UIAs, being cited between 1% and as much as 7% of the general population [39][40][41][42]. They are more commonly found in the anterior circulation, at more advanced ages, and more often in women.…”

Section: Natural History Of Unruptured Aneurysmsmentioning

confidence: 99%

“…At present, there are no corroborated management guidelines for UIAs in elderly patients, yet the retrospective reports reveal excellent results for both treatment strategies [130][131][132]. It has been shown that elderly patients with UIAs are less likely to die following aneurysmal rupture SAH than younger and/or female patients [37,40,78,133,134]. Therefore, a conservative approach may also be considered especially for small UIAs.…”

Section: Aneurysm Clipping In Elderlymentioning

confidence: 99%

Preventing Rupture: Clipping of Unruptured Intracranial Aneurysms

Florian¹,

Aldea²,

Florian³

2020

New Insight Into Cerebrovascular Diseases - An Updated Comprehensive Review

View full text Add to dashboard Cite

Unruptured intracranial aneurysms (UIAs) represent a major public health issue due to their unpredictable natural history. Whether to actively treat them or to maintain them under observation remains a hotly disputed topic. In this chapter, we present a review of the literature regarding the history of clipping and its use in UIAs, as well as the experience of our senior author in this field. We performed an extensive Medline and Google Academic search of the relevant literature. We have also made a retrospective analysis on patients harboring UIAs and multiple intracranial aneurysms (MIAs) clipped by the senior author between 1997 and 2017. About 89 patients had solitary UIAs, alongside 101 with MIAs possessing 257 individual aneurysms in total. All UIA patients were discharged with a favorable neurological outcome and no mortality. Concerning MIAs, the majority of cases had 2 aneurysms, the highest number being 6. And, 61 patients from this group had a favorable outcome. In the hands of experienced vascular neurosurgeons, clipping remains a safe option for both UIAs and MIAs. This procedure offers a long-lasting protection from aneurysmal rupture. In the future, new clip technologies and intraprocedural methods of verifying vessel patency and aneurysmal occlusion may further enhance postoperative results.

show abstract

“…28 Large cohort studies have also demonstrated that the multiplicity of intracranial aneurysms affects the natural course and risk of rupture in VSIAs. 4,29 Further study is required to shed light on the issue. In the report by Bruneau et al, 1 the mortality rate was 0% and the rate of total occlusion was 98.2%, and only 2.7% of patients experienced persistent neurologic complications, which is comparable to our study.…”

Section: Original Articlementioning

confidence: 99%