Tapan Mehta1, Neil Datta1, Smit Patel2, Kathan Mehta2, Mohammed Hussain3, Inaam Kureshi4, Martin Ollenschleger3, Amre Nouh5. 1. Department of Neurology, University of Connecticut Health, Farmington, Connecticut, USA. 2. Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 3. Department of Interventional Neuroradiology, Hartford Hospital, Hartford, Connecticut, USA. 4. Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, USA. 5. Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA.
Abstract
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes; 30-day mortality is as high as 40%. We sought to evaluate outcomes of aSAH patients treated 2004-2014 by endovascular therapy (EVT), to demonstrate associated trends, and to evaluate angioplasty use for aSAH-related cerebral vasospasm. METHODS: The Nationwide Inpatient Sample (NIS) database 2004-2014 was used to derive a study cohort using ICD-9 codes. Survey procedures were used to adjust for stratified cluster design of NIS. NIS trend weights were used to generate national estimates. Mortality during hospitalization and use of angioplasty for aSAH-induced cerebral vasospasm trends were evaluated with multivariate regression analysis. RESULTS: We identified n = 10,822 (weighted n = 52,062) EVT-treated aSAH hospitalizations. Increasing years independently predicted decreased mortality (odds ratio [OR] 0.926, 95% confidence interval [CI] 0.905-0.948, p < 0.0001), decreased utilization of angioplasty (age ≥50 years [OR 0.916, 95% CI 0.867-0.968, p = 0.0019] and age <50 years [OR 0.922, 95% CI 0.879-0.967, p = 0.0009]) after controlling for increasing age, Charlson comorbidity index, and external ventricular drain placement. Angioplasty rates were higher in age <50 years compared to age ≥50 years (5 vs. 3.63%, p < 0.001). CONCLUSION: It is notable that EVT for aSAH management will be an integral and increasingly useful tool for initial aneurysm management. Advances in procedural techniques, operator experience, and periprocedural management could be significant contributors of decreasing mortality and reducing the need for angioplasty for cerebral vasospasm in patients admitted with aSAH.
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes; 30-day mortality is as high as 40%. We sought to evaluate outcomes of aSAH patients treated 2004-2014 by endovascular therapy (EVT), to demonstrate associated trends, and to evaluate angioplasty use for aSAH-related cerebral vasospasm. METHODS: The Nationwide Inpatient Sample (NIS) database 2004-2014 was used to derive a study cohort using ICD-9 codes. Survey procedures were used to adjust for stratified cluster design of NIS. NIS trend weights were used to generate national estimates. Mortality during hospitalization and use of angioplasty for aSAH-induced cerebral vasospasm trends were evaluated with multivariate regression analysis. RESULTS: We identified n = 10,822 (weighted n = 52,062) EVT-treated aSAH hospitalizations. Increasing years independently predicted decreased mortality (odds ratio [OR] 0.926, 95% confidence interval [CI] 0.905-0.948, p < 0.0001), decreased utilization of angioplasty (age ≥50 years [OR 0.916, 95% CI 0.867-0.968, p = 0.0019] and age <50 years [OR 0.922, 95% CI 0.879-0.967, p = 0.0009]) after controlling for increasing age, Charlson comorbidity index, and external ventricular drain placement. Angioplasty rates were higher in age <50 years compared to age ≥50 years (5 vs. 3.63%, p < 0.001). CONCLUSION: It is notable that EVT for aSAH management will be an integral and increasingly useful tool for initial aneurysm management. Advances in procedural techniques, operator experience, and periprocedural management could be significant contributors of decreasing mortality and reducing the need for angioplasty for cerebral vasospasm in patients admitted with aSAH.
Authors: Lei Feng; Brian-Fred Fitzsimmons; William L Young; Mitchell F Berman; Erwin Lin; Beverly D L Aagaard; Hoang Duong; John Pile-Spellman Journal: AJNR Am J Neuroradiol Date: 2002-09 Impact factor: 3.825
Authors: Neeraj Badjatia; Mehmet A Topcuoglu; Johnny C Pryor; James D Rabinov; Christopher S Ogilvy; Bob S Carter; Guy A Rordorf Journal: AJNR Am J Neuroradiol Date: 2004-05 Impact factor: 3.825
Authors: Andrew J Molyneux; Richard S C Kerr; Ly-Mee Yu; Mike Clarke; Mary Sneade; Julia A Yarnold; Peter Sandercock Journal: Lancet Date: 2005 Sep 3-9 Impact factor: 79.321