Institutional members access full text with Ovid®

Comparison of Long-term Outcomes Associated With Endovascular Treatment vs Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms

Qureshi, Adnan I. MD; Chaudhry, Saqib A. MD; Tekle, Wondwossen G. MD; Suri, M. Fareed K. MD

doi: 10.1227/NEU.0000000000000450
Research-Human-Clinical Studies

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 postprocedure 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 who underwent endovascular treatment compared with those who underwent surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups by using Kaplan-Meier 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 postprocedural neurological complications (10.3% vs 3.5%, P = .001) was higher among patients treated with surgery than among those who underwent endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients who underwent surgical and endovascular treatments, respectively. After adjusting for age, sex, and race/ethnicity, the RRs of all-cause mortality (RR, 0.6; 95% confidence interval, 0.3-1.1) and new intracranial hemorrhage (RR, 0.4; 95% confidence interval, 0.2-0.8) were 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.

ABBREVIATIONS: CI, confidence interval

ICD-9-CM, Classification of Diseases, 9th Revision, Clinical Modification

ISAT, International Subarachnoid Aneurysm Trial

RR, relative risk

SAF, Standard Analytic Files

SAH, subarachnoid hemorrhage

SE, standard error

Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota

Correspondence: Saqib A. Chaudhry, MD, Zeenat Qureshi Institute, St. Cloud, MN. E-mail:

Received October 20, 2013

Accepted May 09, 2014

Copyright © by the Congress of Neurological Surgeons