Outpatient Day-care Neuroangiography andNeurointerventionof Unruptured Intracranial Aneurysms

Abstract

PurposeDay-care management of unruptured intracranial aneurysms can shorten hospital stay, reduce medical cost and improve outcome. We present the process, outcome and duration of hospital stay for the management of unruptured intracranial aneurysms via a neurointervention clinic in a single center during the past four years.Materials and MethodsWe analyzed 403 patients who were referred to Neurointervention Clinic at Asan Medical Center for aneurysm evaluation between January 1, 2011 and December 31, 2014. There were 141 (41%) diagnostic catheter angiographies, 202 (59%) neurointerventional procedures and 2 (0.6%) neurointerventional procedures followed by operation. We analyzed the process, outcome of angiography or neurointervention, and duration of hospital stay.ResultsThere was no aneurysm in 58 patients who were reported as having an aneurysm in MRA or CTA (14 %). Among 345 patients with aneurysm, there were 283 patients with a single aneurysm (82%) and 62 patients with multiple aneurysms (n=62, 18%). Aneurysm coiling was performed in 202 patients (59%), surgical clipping in 14 patients (4%), coiling followed by clipping in 2 patients (0.6%) and no intervention was required in 127 patients (37%). The hospital stay for diagnostic angiography was less than 6 hours and the mean duration of hospital stay was 2.1 days for neurointervention. There were 4 procedure-related adverse events (2%) including 3 minor and 1 major ischemic strokes.ConclusionOur study revealed that day-care management of unruptured intracranial aneurysms could be performed without an additional risk. It could enable rapid patient flow, shorten hospital stay and thus reduce hospital costs.

Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques

“…Same-day discharge after neuroangiography has been well-described as both safe and cost-minimizing. [18][19][20][21] As similar advances are made in the microsurgical aneurysm repair cohorts, 11,22,23 the neuroendovascular realm should seek to improve our discharge protocols as well. 24 Early discharge did not increase the rate of readmission nor the overall complication rate.…”

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

“…The procedures were performed under general anesthesia for 902 aneurysms (94.4%), and sedative anesthesia for 54 aneurysms (5.6%). The procedural details have been described previously [ 4 5 8 9 10 11 12 13 14 ]. The femoral approach (n = 954 aneurysms) was routinely used, while the radial approach (n = 2 aneurysms) was used in selected patients.…”

“…Adverse events were defined as any cerebrovascular event (major/minor strokes, hemorrhage, or death) and any cerebrovascular or any other medical problem, as previously described [ 5 16 17 ]. Minor stroke was defined as a new, non-disabling neurological deficit or an increase in the National Institutes of Health Stroke Scale (NIHSS) score of 3, which was completely resolved within 30 days.…”

“…This change in the management of cerebral aneurysms has dramatically contributed to the improvement of outcomes. The anxiety of patients regarding the risk of treatment can be reduced if UIA can be managed by same day care treatment [ 4 5 ]. Therefore, we performed a retrospective single-center cohort study to evaluate the outcome of outpatient day-care management of UIA, and present the risk associated with such management, which may help reduce patients’ anxiety and unnecessary fear by understanding recent outcome data.…”