E-199 Acute imaging following elective brain aneurysm treatment. (23rd July 2022)

• Record Type: Journal Article
• Authors: Lauzier, D; Cler, S; Jayaraman, K; Chatterjee, A; Osbun, J; Moran, C; Kansagra, A
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A186
• Page End: A186
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.310
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: Elective treatment of intracranial aneurysms comprises a significant share of neurointerventional practice. Following treatment, patients are typically monitored in the hospital due to the risk of acute complications, but the benefits of such monitoring warrant study given the associated cost. Changes in neurologic examination or development of other acute symptoms may prompt workup that often includes cross-sectional imaging, and such imaging can therefore be used as a proxy metric of the need for hospital resources following treatment. Here, we review the frequency, indications, yield, and risk factors for cross-sectional imaging after elective endovascular aneurysm treatment. Methods: Clinical and angiographic data from eligible patients were retrospectively assessed for demographics, imaging indications, time of imaging, and imaging findings. Patients were included if they underwent elective aneurysm treatment. Modes of imaging recorded were computerized tomography (CT), magnetic resonance imaging (MRI), angiography, and doppler studies. Plain radiographs were excluded. To quantify the association between potential risk factors and the need for any imaging following elective aneurysm treatment, a multivariate logistic regression was performed. Risk factors included patient demographics, comorbidities, aneurysm morphology, aneurysm size, aneurysm location, number of aneurysms treated, indication for treatment, and treatment type. Results: In total, 1418 aneurysms were electively treated in 1329 endovascular procedures. 14.4% (191/1329) of procedures had associated cross-sectional imaging prior to patient discharge. This included 11.9% (158/1329) of cases requiring neuroimaging and 2.6% (35/1329) of cases with other body imaging. The most common indications for imaging were development of symptoms, followed by occurrence of observed intraprocedural events and laboratory abnormalities. Median time from procedure completion to acquisition of post-procedure imaging was 933 minutes (IQR 247–1385) for neuroimaging and 953 minutes (IQR 326–1808) for body imaging. Positive findings were identified after 32.8% (61/158) of cases with neuroimaging performed and 60.0% (21/35) of cases with body imaging performed. In our multivariate analysis, need for any post-treatment imaging prior to discharge was positively associated with a history of cardiovascular disease (p=0.016), larger aneurysms (p=0.008), use of stent-assisted coiling (p=0.016), and use of X or Y stenting (p=0.019). Conclusions: A significant minority of patients received cross-sectional imaging during the hospitalization immediately following elective aneurysm treatment. Risk factors for post-treatment cross-sectional imaging included cardiovascular disease, larger aneurysm size, stent-assisted coiling, and X or Y stenting. These results shed light on the benefits of hospitalization following elective endovascular aneurysm treatment. Disclosures: D. Lauzier: None. S. Cler: None. K. Jayaraman: None. A. Chatterjee: None. J. Osbun: 2; C; Medtronic, Microvention. C. Moran: 2; C; Medtronic, Cerenovus, Microvention, Stryker, Balt. A. Kansagra: 2; C; Microvention, Penumbra.