Introduction of endovascular embolization for intracranial aneurysms in a low-volume institution.
BACKGROUND
Studies indicate a relationship between hospital caseload and health outcomes after both surgical and endovascular repair of intracranial aneurysms.


OBJECTIVE
To evaluate outcomes after introduction of endovascular embolization for intracranial aneurysms in a low-volume regional university hospital.


METHODS
Retrospective study of 243 consecutive patients treated for 284 intracranial aneurysms with endovascular embolization or surgical clipping from 2000 to 2006 at the University Hospital of North Norway. Postoperative complications were registered. The Glasgow Outcome Scale (GOS) was used for assessment of outcome.


RESULTS
The mean annual number of procedures was 39 (microsurgery 23, embolization 16). Seventy-four percent of patients with ruptured aneurysms and all patients with unruptured aneurysms had a favorable outcome (GOS 4 or 5) at 1 year follow-up. Patients with subarachnoid hemorrhage were more likely to experience postoperative complications than patients treated for unruptured aneurysms (42% versus 8% of the patients, P<0.01). The immediate incomplete occlusion rate (Raymond II-III) in the initial embolization procedure was 29%. Ten endovascularly treated patients and one surgically treated patient required retreatments due to residual aneurysm or neck remnants.


CONCLUSIONS
The present study indicates that acceptable outcome from aneurysm treatment, both endovascular and microsurgical, is possible in a low-volume institution.
Lindekleiv
H M
HM
Department of Radiology, University Hospital of North Norway, Tromsø, Norway.
Jacobsen
E A
EA
Kloster
R
R
Sandell
T
T
Isaksen
J G
JG
Romner
B
B
Ingebrigtsen
T
T
Bajic
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009664:Norway; D011183:Postoperative Complications; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016896:Treatment Outcome; D016526:Workload; D055815:Young Adult