title: In-hospital outcomes associated with stent-assisted endovascular treatment of unruptured cerebral aneurysms in the USA.
abstract: BACKGROUND
  Adjunctive stenting has increasingly become an acceptable option for the endovascular treatment of unruptured aneurysms. The Nationwide Inpatient Sample (NIS) was used to compare US in-hospital outcomes related to coiling with and without adjunctive stenting for unruptured aneurysms.
  
  
  METHODS
  Hospitalizations for coiling of unruptured cerebral aneurysms from 2004 to 2008 were identified in the NIS by extracting ICD-9-CM codes for the diagnosis of unruptured aneurysm (437.3) and intracranial stenting (00.65) with coiling (39.52, 39.79 or 39.72) of cerebral aneurysms. All patients with a diagnosis of subarachnoid hemorrhage (430) and/or intracerebral hemorrhage (431) were excluded. Mortality and discharge to a long-term facility were compared between stent and non-stent patient groups using multivariate regression analysis.
  
  
  RESULTS
  Patients treated with stent-assisted coiling had an in-hospital mortality rate of 0.08-0.8% compared with a death rate of 0.5% (95% CI 0.3% to 0.7%) for patients who did not receive a stent during coiling (p=0.36). Patients in the stent group had a 3% rate of discharge to a care facility (95% CI 1.5% to 5.8%) compared with 5% (95% CI 4.5% to 5.6%) for those in the non-stent group (p=0.14). Patients treated with a stent had a similar likelihood of in-hospital mortality (adjusted OR, 2.12 (95% CI 0.32 to 7.11), p=0.34) and a lower likelihood of discharge to a long-term care facility (adjusted OR 0.59 (95% CI 0.24 to 1.16), p=0.16) compared with the non-stent group.
  
  
  CONCLUSIONS
  Adjunctive stenting adds little in-hospital risk to the endovascular treatment of cerebral aneurysms. However, the need for dual antiplatelet therapy may predispose to delayed hemorrhagic complications and discontinuation of dual antiplatelet therapy may lead to delayed thromboembolic complications.
authors.affiliation: Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. mcdonald.jennifer@mayo.edu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Norgan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McDonald
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D000368:Aged; D016208:Databases, Factual / Q000639:trends; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D038801:International Classification of Diseases / Q000639:trends; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000628:therapy*; D008134:Long-Term Care / Q000379:methods / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology