Introduction: Routine admission to ICU care is a common practice after endovascular embolization of unruptured aneurysms. We sought to assess the safety of selective admission to a regular ward based on case complexity and intra-procedural findings after elective endovascular treatment of unruptured intracranial aneurysms.
Methods: A prospective consecutive series of 200 elective unruptured aneurysms was collected. The safety, need for unplanned ICU admission, and presence of any complication preventable by ICU admission were analized.
Results: Two-hundred aneurysms were treated in 172 patients, aged 56±13(years), 78%female. Fifty-five% were incidental, 27% symptomatic, and 18% with other aneurysmal SAH. Sixty-eight% were small, 7% were giant, 18.5% were posterior circulation. Treatment included coiling(62%), Pipeline(PED)25.5%, and stent/balloon-assisted-coiling (3.5%). Fifty-nine% went to floor care, 6.5% discharged same-day, 34.5% went to ICU. One patient transfered from floor to ICU due to thromboembolic symptoms. Peri-operative complications were segregated into 4 categories (incidence) thromboembolic(4%), hemorrhagic(3%), access site complications(1.5%), and other(1%). Thirty-day all cause mortality was 1% permanent morbidity related to inpatient events was 1%. Factors for ICU admission included aneurysm complexity, intra-operative complications, or initial experience with novel endovascular devices. ICU patients had larger aneurysms (12.6±9.2mm vs7.7±4.7mm p<0.005) and had symptomatic aneurysms (37.7% vs21.3% floor). Subgroup analysis revealed that thrombotic events were more commonly seen after stent-assisted-coiling (22.2% vs1.6% coiled), posterior circulation aneurysms (10.8% vs2.5% anterior) and with larger aneurysms (15.0±10.8mm vs9.1±6.7mm, p=0.0199). Similarly, hemorrhagic complications were more often associated with coiling (4.0%vs 1.9% of PED) and in women (3.8%vs 0%of men).
Conclusions: Complications following elective endovascular aneurysm treatments are most often seen during the procedure or immediately upon awakening from anesthesia. The Intra-operative complications, large aneurysms, or complexity may predispose to ICU. In the absence of these complications or predispositions, patients may safely be observed on the floor.
Patient Care: By allowing patients to be safely observed under less acute conditions.
Learning Objectives: 1. Patients with electively treated aneurysms may be monitored on the floor.