title: Comparison of long-term outcomes associated with endovascular treatment vs surgical treatment among Medicare beneficiaries with unruptured intracranial aneurysms.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Chaudhry
authors.forename: Wondwossen G
authors.initials: WG
authors.lastname: Tekle
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D006278:Medicare; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States