Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

  • Dae Chul Suh (Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yun Hyeok Choi (Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Ik Park (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Suyoung Yun (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • So Yeong Jeong (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Soo Jeong (Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Boseong Kwon (Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yunsun Song (Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.02.20
  • Accepted : 2022.05.06
  • Published : 2022.08.01
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Abstract

Objective: This study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods. Materials and Methods: This retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage. Results: The mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6-53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6-53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes. Conclusion: This study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

Keywords

Acknowledgement

We thank Minkyu Han Ph.D. for statistical analysis.

References

  1. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G; European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013;35:93-112 
  2. Cho SH, Lee JY, Ryu KH, Suh DC. Diagnosis of cerebral aneurysm via magnetic resonance angiography screening: emphasis on legal responsibility increases false positive rate. Neurointervention 2018;13:48-53 
  3. Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:2368-2400 
  4. Jeong YG, Kim EH, Hwang SM, Lee GY, Kim JW, Choi YJ, et al. Outpatient (same-day care) neuroangiography and neurointervention. Neurointervention 2012;7:17-22 
  5. Liu H, Park D, Hwang SM, Lee GY, Lim OK, Kim M, et al. Outpatient day-care neuroangiography and neurointervention of unruptured intracranial aneurysms. Neurointervention 2016;11:37-41 
  6. Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957;2:200-215 
  7. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-607 
  8. Song Y, Kwon B, Al-Abdulwahhab AH, Kurniawan RG, Suh DC. Microcatheter stabilization technique using partially inflated balloon for coil embolization of paraclinoid aneurysms. Neurointervention 2021;16:132-140 
  9. Kurniawan RG, Song Y, Kwon B, Ahn Y, Suh DC. Tailored antiplatelet agent medication in clopidogrel hyporesponsive patients before stent-assisted coiling: single-center experience. Neuroradiology 2020;62:1709-1715 
  10. Song Y, Sheen JJ, Jia ZY, Kim JG, Chung J, Park D, et al. Stent-assisted coil embolization of MCA bifurcation aneurysms at a hypoplastic M1 branch by use of hook technique. World Neurosurg 2019;128:e615-e620 
  11. Lee D, Song Y, Shin JH, Suh DC. Low-dose prasugrel in patients with resistance to clopidogrel for the treatment of cerebral aneurysms: follow-up of over 6 months. Neurointervention 2019;14:68-70 
  12. Lee D, Song Y, Han M, Park D, Suh DC. Low-dose prasugrel in patients with resistance to clopidogrel for the treatment of cerebral aneurysms. Neurointervention 2018;13:124-127 
  13. Jia ZY, Song YS, Sheen JJ, Kim JG, Lee CW, Suh DC. Loop microcatheter technique for coil embolization of paraclinoid aneurysms. Acta Neurochir (Wien) 2018;160:1755-1760 
  14. Sheen JJ, Suh DC. Low-angled microcatheter approach for coil embolization of the anterior choroidal artery aneurysm. Neuroradiology 2017;59:1053-1056 
  15. Jia ZY, Shi HB, Miyachi S, Hwang SM, Sheen JJ, Song YS, et al. Development of new endovascular devices for aneurysm treatment. J Stroke 2018;20:46-56 
  16. Suh DC, Kim JK, Choi JW, Choi BS, Pyun HW, Choi YJ, et al. Intracranial stenting of severe symptomatic intracranial stenosis: results of 100 consecutive patients. AJNR Am J Neuroradiol 2008;29:781-785 
  17. Lu PH, Park JW, Park S, Kim JL, Lee DH, Kwon SU, et al. Intracranial stenting of subacute symptomatic atherosclerotic occlusion versus stenosis. Stroke 2011;42:3470-3476 
  18. Goland J, Doroszuk G, Ypa P, Leyes P, Garbugino S. Outpatient treatment of cerebral aneurysms: a case series. Surg Neurol Int 2020;11:400 
  19. Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G, Kouznetsov E, et al. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 2013;84:42-48 
  20. Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016;12:699-713 
  21. Naggara ON, Lecler A, Oppenheim C, Meder JF, Raymond J. Endovascular treatment of intracranial unruptured aneurysms: a systematic review of the literature on safety with emphasis on subgroup analyses. Radiology 2012;263:828-835 
  22. Li Y, Dai W, Zhang J. Anxiety, depression and quality of life in patients with a treated or untreated unruptured intracranial aneurysm. J Clin Neurosci 2017;45:223-226 
  23. Suh SH. The annual trends between neurointerventional and neurosurgical procedures in Korea: analysis using HIRA data from 2010 to 2016. Neurointervention 2017;12:77-82 
  24. Brinjikji W, Rabinstein AA, Nasr DM, Lanzino G, Kallmes DF, Cloft HJ. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008. AJNR Am J Neuroradiol 2011;32:1071-1075 
  25. Hwang JS, Hyun MK, Lee HJ, Choi JE, Kim JH, Lee NR, et al. Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol 2012;12:99 
  26. Park YK, Yi HJ, Choi KS, Lee YJ, Chun HJ. Intraprocedural rupture during endovascular treatment of intracranial aneurysm: clinical results and literature review. World Neurosurg 2018;114:e605-e615