Ahead of Print: Long-term Outcomes of Aneurysm Treatment

Background: Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date.

Objective: To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment.

Methods: The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged >=65 years who underwent endovascular or surgical treatment for unruptured intracranial aneurysms with post-procedure follow-up of 4.7 (+/-3.0) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality, new intracranial hemorrhage, or second procedure for patients treated with endovascular treatment compared with those treated with surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups using Kaplan Meir survival methods.

Results: A total of 688 patients with unruptured intracranial aneurysms were treated with either endovascular (n=398) or surgical treatment (n=290). The rate of immediate post-procedural neurological complications (10.3% vs. 3.5%, p=0.0003) was higher among patients treated with surgery compared with those treated with endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients treated with surgical and endovascular treatments, respectively. After adjusting for age, gender, and race/ethnicity, relative risks of all-cause mortality (RR 0.6, 95% confidence interval [CI] 0.3 – 1.1) and new intracranial hemorrhage (RR 0.4, 95% CI 0.2 – 0.8) were significantly lower with endovascular treatment.

Conclusion: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.

From: Comparison of Long-term Outcomes Associated With Endovascular Treatment Versus Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms by Qureshi et al.

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