Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

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.

Effect of exercise-nutrition-psychology oriented nursing in patients undergoing interventional embolization for intracranial aneurysm

“…The results suggest that exercise-nutrition-psychology oriented nursing intervention has a positive impact on improving the quality of life of patients with cerebral aneurysms. This nursing model starts from patients' cognition, beliefs and behaviors, helps patients form correct cognition, enhances their healthy beliefs, and makes them willing to take the initiative to adopt scientific and correct behaviors in their lives, so as to promote the regression of disease, which helps to improve the quality of their life [27,28].…”

Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery

“…Generally, less complex procedures, such as brain biopsies, resection of supratentorial brain tumors, stereotactic procedures, and endoscopic procedures, are considered suitable for SDNS, whereas complex procedures, such as craniotomy for aggressive brain tumors and complex vascular procedures, may require an overnight hospital stay [5]. Of late, SDNS has been explored safely in the setting of interventional neuroradiological treatment as well as awake clipping of unruptured anterior circulation aneurysms [6,7].…”

Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck

“…With the in-depth understanding of aneurysm formation and the development of endovascular devices, endovascular treatment for the unruptured intracranial aneurysm and management of a patient with the aneurysm have been advanced recently. [1][2][3][4][5] The circle of Willis (CoW), a basal network of cerebral arteries connecting to the brain circulation, includes the anterior communicating artery (ACoA) and posterior communicating artery (PCoA) as important elements. This junction area in the CoW was found to be the most likely geographic area to harbor the formation of an aneurysm.…”

“…With the in-depth understanding of aneurysm formation and the development of endovascular devices, endovascular treatment for the unruptured intracranial aneurysm and management of a patient with the aneurysm have been advanced recently [ 1 - 5 ].…”