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: firstname.lastname@example.org
Received October 20, 2013
Accepted May 09, 2014