scholarly journals Initial Treatment for Unruptured Intracranial Aneurysm and Its Follow-up: A Cost Analysis of Pipeline Flow Diverters versus Coiling

Cureus ◽  
2019 ◽  
Author(s):  
Spencer Twitchell ◽  
Herschel W Wilde ◽  
Philipp Taussky ◽  
Michael Karsy ◽  
Ramesh Grandhi
Keyword(s):  
Intracranial Aneurysm ◽  
Cost Analysis ◽  
Initial Treatment ◽  
Unruptured Intracranial Aneurysm ◽  
Pipeline Flow ◽  
Flow Diverters

Abstract TP295: Stroke Prevention Surgery > Quality of Life and Cognitive Ability to Drive Are Maintained After Surgical Repair of Unruptured Intracranial Aneurysm

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joan M ODonnell ◽  
Maurizio Manuguerra ◽  
Jemma L Hodge ◽  
Greg Savage ◽  
Michael K Morgan
Keyword(s):  
Quality Of Life ◽  
Intracranial Aneurysm ◽  
Surgical Management ◽  
Cognitive Abilities ◽  
Short Form ◽  
Unruptured Intracranial Aneurysm ◽  
Significant Difference ◽  
Ability To Drive

Background: Studies have questioned the effectiveness of surgery for the management of unruptured intracranial aneurysm (uIA). Few studies have examined the ability to drive and quality of life (QOL) after surgery for uIA. Objective: This study examined the effectiveness of surgical management of uIA by measuring patients’ perceived quality of life and their cognitive abilities related to driving. Methods: Between January 2011 and January 2016 patients with a uIA were assessed using the Quality Metric Short Form 36 (SF36) and the off-road driver screening instrument DriveSafeDriveAware. Reassessments were conducted at the 6-week post-operative follow-up for surgical patients and at 12-month follow-up for surgical and conservatively managed patients. Results: 175 patients enrolled in the study, of which 112(66%) had surgical management of their aneurysm. For the surgical cases who completed all assessments (N=74), there was a trend for the DriveSafe pre-operative mean score of 108 (SD 10.7) to be lower than the 6-week and 12-month post-operative mean scores (111 SD 9.7 and 112 SD 10.2 respectively)(p=0.05). There were no significant changes in DriveAware scores at any epoch or between patient groups nor in the MCS in the surgical group.. There was a significant decline in PCS scores at 6 weeks post-operatively which recovered at 12 months (52 SD 8.1, 46 SD 6.8 and 52 SD 7.1 respectively)( p <0.01). There was no significant difference in 12-month mRS scores between the surgical cases who completed with cases who did not complete all assessments. Conclusion: Surgery for uIA did not affect cognitive abilities for driving at 6 weeks or 12 months after surgery. There was a decline in the QOL in the first months after surgery, however QOL returned to pre-surgical status 12 months after surgery. If the risk of seizures is low and there are no post-operative complications, returning to driving can be recommended.

scholarly journals Atorvastatin and growth, rupture of small unruptured intracranial aneurysm: results of a prospective cohort study

2021 ◽  
Vol 14 ◽  
pp. 175628642098793
Author(s):  
Jie Wang ◽  
Jiancong Weng ◽  
Hao Li ◽  
Yuming Jiao ◽  
Weilun Fu ◽  
...  
Keyword(s):  
Growth Rate ◽  
Cohort Study ◽  
Intracranial Aneurysm ◽  
Aneurysm Rupture ◽  
Uncontrolled Hypertension ◽  
Unruptured Intracranial Aneurysm ◽  
Multicenter Cohort Study ◽  
Aneurysm Growth ◽  
Cox Analysis

Background and aims: The role of statins in unruptured intracranial aneurysm (UIA) growth and rupture remains ambiguous. This study sought to determine whether atorvastatin is associated with aneurysm growth and rupture in patients harboring UIA <7 mm. Methods: This prospective, multicenter cohort study consecutively enrolled patients with concurrent UIA <7 mm and ischemic cerebrovascular disease from four hospitals between 2016 and 2019. Baseline and follow-up patient information was recorded. Because of the strong anti-inflammatory effect of aspirin, patients using aspirin were excluded. Patients taking atorvastatin 20 mg daily were atorvastatin users. The primary and exploratory endpoints were aneurysm rupture and growth, respectively. Results: Among the 1087 enrolled patients, 489 (45.0%) took atorvastatin, and 598 (55%) took no atorvastatin. After a mean follow-up duration of 33.0 ± 12.5 months, six (1.2%) and five (0.8%) aneurysms ruptured in atorvastatin and non-atorvastatin groups, respectively. In the adjusted multivariate Cox analysis, UIA sized 5 to <7 mm, current smoker, and uncontrolled hypertension were associated with aneurysm rupture, whereas atorvastatin [adjusted hazard ratio (HR) 1.495, 95% confidence interval (CI) 0.417–5.356, p = 0.537] was not. Of 159 patients who had follow-up imaging, 34 (21.4%) took atorvastatin and 125 (78.6%) took no atorvastatin. Aneurysm growth occurred in five (14.7%) and 21 (16.8%) patients in atorvastatin and non-atorvastatin groups (mean follow-up: 20.2 ± 12.9 months), respectively. In the adjusted multivariate Cox analysis, UIAs sized 5 to <7 mm and uncontrolled hypertension were associated with a high growth rate; atorvastatin (adjusted HR 0.151, 95% CI 0.031–0.729, p = 0.019) was associated with a reduced growth rate. Conclusions: We conclude atorvastatin use is associated with a reduced risk of UIA growth, whereas atorvastatin is not associated with UIA rupture. The trial registry name: The Clinic Benefit and Risk of Oral Aspirin for Unruptured Intracranial Aneurysm Combined With Cerebral Ischemia Clinical Trial Registration-URL: http://www.clinicaltrials.gov Unique identifier: NCT02846259

scholarly journals Unruptured Intracranial Aneurysm Initial Treatment and Follow-up Cost Analysis: Pipeline Flow Diverters vs Coiling

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Herschel Wilde ◽  
Spencer Twitchell ◽  
Michael Karsy ◽  
Philipp Taussky ◽  
Ramesh Grandhi
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Techniques ◽  
Analysis Pipeline ◽  
Unruptured Intracranial Aneurysm ◽  
Discharge Disposition ◽  
Aneurysm Treatment ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Flow Diverters

Abstract INTRODUCTION Intracranial aneurysms represent a relatively common epidemiological problem, with a prevalence of 3% to 5% in the U.S. Surveillance and treatment remain costly enterprises especially with the advent of safer endovascular techniques, including coiling and pipeline embolization devices (PEDs). While a number of studies have evaluated aneurysm treatment cost, inclusion of follow-up costs had been limited. We sought to examine how follow-up costs after treatment could impact overall cost for different endovascular techniques. METHODS The value driven outcomes (VDO) database was used to evaluate the upfront and follow-up costs of electively treated patients who underwent coiling or PED for intracranial aneurysms from July 2011 to December 2017. RESULTS A total of 114 patients (n = 37 coiled, n = 77 PED) were included with no difference in age (61.3 ± 12.8 vs 57.0 ± 14.5 yr, P = .2), gender (males: 32.4% vs 22.1%, P = .2), American Society of Anesthesiologists (ASA) grade (P = .5), discharge disposition (P = .1), length of stay (3.1 ± 5.5 vs 2.4 ± 2.6 d, P = .2) or follow-up (22.7 ± 18.5 vs 18.6 ± 14.9 mo, P = .2). No differences in admission treatment (P = .5) or follow-up (P = .3) costs were seen for coiling or PED treatments. Initial costs were predominantly supplies/implants (56.1% vs 63.7%) for both coiling and PED. Follow-up costs were mostly facility costs (68.2% vs 67.5%) without differences in supplies/implants (10.5% vs 9.4%) or imaging (17.0% vs 17.8%) costs between coiling and PED. No differences in subgroup (eg, facility, supplies/implants, pharmacy, imaging, laboratory) costs were also observed. CONCLUSION These results suggested that coiling or PED could be used for aneurysm treatment in a cost-conscious manner when factoring both upfront and follow-up costs.

Unruptured intracranial aneurysm follow-up and treatment after morphological change is safe: observational study and systematic review

2016 ◽  
Vol 87 (12) ◽  
pp. 1277-1282 ◽  
Author(s):  
Renato Gondar ◽  
Oliver Pascal Gautschi ◽  
Johanna Cuony ◽  
Fabienne Perren ◽  
Max Jägersberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Study ◽  
Intracranial Aneurysm ◽  
Morphological Change ◽  
Unruptured Intracranial Aneurysm

scholarly journals Aspirin and Growth of Small Unruptured Intracranial Aneurysm

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3045-3054
Author(s):  
Jian-Cong Weng ◽  
Jie Wang ◽  
Hao Li ◽  
Yu-Ming Jiao ◽  
Wei-Lun Fu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Intracranial Aneurysm ◽  
Blood Pressure Level ◽  
Hazard Ratio ◽  
Low Risk ◽  
Unruptured Intracranial Aneurysm ◽  
High Risk Patients ◽  
Risk Patients

Background and Purpose: The role of aspirin in unruptured intracranial aneurysm (UIA) growth remains largely unknown. We aim to identify whether aspirin is associated with a lower rate of UIA growth in patients with UIA <7 mm. Methods: This prospective cohort study consecutively enrolled patients with UIAs <7 mm with ischemic cerebrovascular disease between January 2016 and December 2019. Baseline and follow-up patient information, including the use of aspirin and blood pressure level, were recorded. Patients were considered aspirin users if they took aspirin, including standard- and low-dose aspirin, ≥3× per week. The primary end point was aneurysm growth in any direction or an indisputable change in aneurysm shape. Results: Among the 315 enrolled patients, 272 patients (86.3%) underwent imaging examinations during follow-up (mean follow-up time, 19.6±12.7 months). A total of 113 patients were continuously treated with aspirin. UIA growth occurred in 31 (11.4%) patients. In the multivariate Cox analysis, specific aneurysm locations (anterior communicating artery, posterior communicating artery, or middle cerebral artery; hazard ratio, 2.89 [95% CI, 1.22–6.88]; P =0.016) and a UIA size of 5 to <7 mm (hazard ratio, 7.61 [95% CI, 3.02–19.22]; P <0.001) were associated with a high risk of UIA growth, whereas aspirin and well-controlled blood pressure were associated with a low risk of UIA growth (hazard ratio, 0.29 [95% CI, 0.11–0.77]; P =0.013 and hazard ratio, 0.25 [95% CI, 0.10–0.66]; P =0.005, respectively). The cumulative annual growth rates were as high as 40.0 and 53.3 per 100 person-years in the high-risk patients (>1 risk factor) with and without aspirin, respectively. Conclusions: Aspirin therapy and well-controlled blood pressure are associated with a low risk of UIA growth; the incidence of UIA growth in high-risk patients in the first year is high, warranting intensive surveillance in this patient group. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02846259.

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