Introduction: Improved outcomes for endovascular management of intracranial aneurysms have been documented, however, it is unclear if this is attributable to increased use of endovascular therapy in patients with less severe presentations. In addition, the impact of evolving aneurysm management strategies on outcomes for subgroups of patients with distinct prognoses has yet to be investigated.
Methods: To evaluate outcomes, we compared two periods of aneurysm management, 1998–2003 (n=1049 patients) and 2007–2013 (n=1500 patients), at a single institution using a previously developed Outcome Classification for Aneurysms (OC-A) score to account for known predictors of outcome. 1 point each was assigned for age >50 years, Hunt and Hess grade 4-5, Fisher score 3-4, and aneurysm size >10 mm.
Results: Utilization of endovascular therapy increased from 24.9% in 1998-2003 to 32.1% in 2007-2013 (P<0.0001). Aneurysms with higher OC-A scores were more frequently treated with endovascular threapy. For total aneurysm treatment, there were significant improvements in proportion of good/excellent outcomes (mRS 0/1) for scores 0 (4.37%, P=0.0027), 1 (9.67%, P<0.0001), 2 (17.5%, P<0.0001), and 3 (26.5%, P<0.0001). For endovascular treatment, improvement in mRS was significant for scores 1 (12.4%, P<0.0001), 2 (19.9%, P=0.00201), and 3 (32.9%, P=0.0035). For open surgery, improvement in mRS was significant for score 2 (16.0%, P=0.00111) and trended toward significance for scores 1 and 3. Proportion of good/excellent outcomes was not significantly different across all OC-A scores for surgery versus endovascular therapy.
Conclusions: We report significant improvements in good/excellent outcomes for overall aneurysm treatment using a risk score which incorporates both ruptured and unruptured aneurysms. There was greater improvement for endovascular therapy versus open surgery. Improvements in overall outcomes likely reflect increased utilization of endovascular strategies, improved neurocritical care, and judicious selection of aneurysms for surgical or endovascular therapy.
Patient Care: By defining which strategies dictate improved outcomes
Learning Objectives: By the conclusion of this session, participants should be able to (1) define outcomes for (i) overall, (ii) surgical, and (iii) endovascular treatment of intracranial aneurysms for subgroups of patients with distinct prognoses comparing two periods of aneurysm management (1998-2003 versus 2007-2013) and (2) identify/evaluate factors contributing to improved outcomes