Abstract Details

Title Comparison of Long-Term Outcomes Associated with Endovascular Treatment Versus Surgical Treatment among Medicare Beneficiaries with Unruptured Intracranial Aneurysms

Topic Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 085

Objective

Background BACKGROUND: In elderly patients with unruptured intracranial aneurysms lower rates of acute adverse events following endovascular treatment are usually associated.

Design/Methods DESIGN/METHODS: The study included a sample of fee-for-service Medicare beneficiaries aged 65 years or older who underwent endovascular or surgical treatment for unruptured intracranial aneurysms between 1999 through 2010. The Medicare Provider Analysis and Review files were linked to Center for Medicaid and Medicare Services denominator files 2000-2010 to ascertain any new admission or mortality. Cox proportional hazards and Kaplan Meir survival analyses were used to assess the relative risk of all-cause mortality, new intracranial hemorrhage (ICH), or second procedure for patients treated with endovascular treatment compared with those treated with surgical treatment after adjusting for potential confounders.

Results RESULTS: A total of 1005 patients with unruptured intracranial aneurysms were treated with either endovascular (n=569) or surgical treatment (n=436) with post-procedure follow-up available for 4.64 (±2.98) years. The rate of immediate post-procedural neurological complications (8.7% vs. 3.2%, p<0.0001) and requirement for intraventricular catheter (2.8% vs. 0.7%, p=0.019) was higher among patients treated with surgery compared with those treated with endovascular treatment. The in hospital mortality during index hospitalization was 6.2% and 4.0% in patients treated with surgical and endovascular treatments, respectively. The estimated 5 year survival was 93.6% and 95.8% in patients treated with surgical and endovascular treatments, respectively. After adjusting for age, gender, and race/ethnicity, relative risks of all-cause mortality (RR 0.5, 95% CI 0.3-0.9) and new intracranial hemorrhage(RR 0.4, 95% CI 0.2-0.8) were significantly lower with endovascular treatment.

Conclusions CONCLUSIONS: 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 ICH.

Authors/Disclosures
Hamza I. Maqsood, MD (Dept of Neurology) PRESENTER	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Saqib A. Chaudhry, MD	Dr. Chaudhry has nothing to disclose.
Wondwossen G. Tekle, MD	Dr. Tekle has nothing to disclose.
	No disclosure on file
	No disclosure on file

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