Understanding complication rates in elective endovascular aneurysm repair for consideration of same-day discharge.

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2026-09-17 DOI:10.1007/s00234-026-04185-4

Aliana N Rao, Theodore C Hannah, Emily B Harvey, Erin K M Graves, Eric T Quach, Kadir Erkmen, Rami O Almefty

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引用次数: 0

Abstract

Objective: Elective repair of unruptured intracranial aneurysms (UIA) is performed to prevent potentially catastrophic rupture. There exists potential for outpatient elective endovascular aneurysm repair given low risk for complications. However, concern remains for development of delayed post-operative complications, which has led to overnight observation being common practice. We aim to determine this practice's necessity by identifying rate and timing of delayed complications and associated factors.

Methods: All patients undergoing elective endovascular UIA treatment between 2014 and 2024 were included. Demographic and clinical data, including primary aneurysm location and size, complications, anticoagulant/antiplatelet (AC/AP) use, and discharge destination was collected.

Results: Of 151 patients, 4 experienced intra-operative complications and 9 (5.9%) experienced post-operative complications. The average time to post-operative complication was 4.67 hours. MCA aneurysms were found to be an independent risk factor for peri-procedural complication (OR = 9.65, 95% CI: 1.15-80.7, p = 0.03). Conversely, no peri-procedural complications were seen when treating posterior circulation aneurysms. Although a significant proportion of peri-procedural complications were associated with bleeding, the rate of peri-procedural complications was not significantly higher in those on AC/AP. All but two peri-procedural complications resolved by discharge, with one resolving upon follow-up. The rate of permanent deficit from peri-procedural complications was 0.66%.

Conclusion: Elective repair of UIA carries a low post-operative complication rate (5.9%) and a very low permanent complication rate (0.66%) in this study. The incidence of delayed complication is low, however, it does occur at a mean time of nearly 5 hours and up to 24 hours requiring additional hospital-based services for diagnosis and management. Based on these findings, we advocate for continued practice of overnight observation.

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了解择期血管内动脉瘤修复术当日出院的并发症发生率。

目的：对未破裂的颅内动脉瘤（UIA）进行选择性修复，以防止潜在的灾难性破裂。由于并发症风险低，门诊选择性血管内动脉瘤修复存在潜力。然而，对延迟术后并发症的发展的担忧仍然存在，这导致过夜观察是常见的做法。我们的目的是通过确定延迟并发症和相关因素的发生率和时间来确定这种做法的必要性。方法：纳入2014 - 2024年间所有接受择期血管内UIA治疗的患者。收集人口统计学和临床数据，包括原发性动脉瘤的位置和大小、并发症、抗凝/抗血小板（AC/AP）的使用和出院目的地。结果：151例患者中出现术中并发症4例，术后并发症9例（5.9%）。术后发生并发症的平均时间为4.67小时。MCA动脉瘤是围手术期并发症的独立危险因素（OR = 9.65, 95% CI: 1.15 ~ 80.7, p = 0.03）。相反，治疗后循环动脉瘤时未见围手术期并发症。虽然术中并发症与出血相关的比例很大，但AC/AP组术中并发症的发生率并没有明显升高。除两例手术期并发症外，其余并发症均在出院时解决，其中一例在随访时解决。术中并发症导致的永久性缺损率为0.66%。结论：本研究择期修复UIA术后并发症发生率低（5.9%），永久性并发症发生率极低（0.66%）。延迟并发症的发生率很低，但是，它的平均发生时间接近5小时，最长可达24小时，需要额外的医院诊断和管理服务。基于这些发现，我们主张继续进行夜间观察。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.