Autosomal Dominant Polycystic Kidney Disease and Intracranial Aneurysms: Is There an Increased Risk of Treatment?
OBJECTIVE
Autosomal dominant polycystic kidney disease is associated with an increased risk of intracranial aneurysms. Our purpose was to assess whether there is an increased risk during aneurysm coiling and clipping.


METHODS
Data were obtained from the National Inpatient Sample (2000-2011). All subjects had an unruptured aneurysm clipped or coiled and were divided into polycystic kidney (n = 189) and control (n = 3555) groups. Primary end points included in-hospital mortality, length of stay, and total hospital charges. Secondary end points included the International Classification of Diseases, Ninth Revision codes for iatrogenic hemorrhage or infarction; intracranial hemorrhage; embolic infarction; and carotid and vertebral artery dissections.


RESULTS
There was a significantly greater incidence of iatrogenic hemorrhage or infarction, embolic infarction, and carotid artery dissection in the patients with polycystic kidney disease compared with the control group after endovascular coiling. There was also a significantly greater incidence of iatrogenic hemorrhage or infarction in the polycystic kidney group after surgical clipping. However, the hospital stay was not longer in the polycystic kidney group, and the total hospital charges were not higher. Additional analysis within the polycystic kidney group revealed a significantly shorter length of stay but similar in-hospital costs when subjects underwent coiling versus clipping.


CONCLUSIONS
Patients with polycystic kidney disease face an increased risk during intracranial aneurysm treatment, whether by coiling or clipping. This risk, however, does not translate into longer hospital stays or increased hospital costs. Despite the additional catheterization-related risks of dissection and embolization, coiling results in shorter hospital stays and similar mortality compared with clipping.
From the Department of Radiology (M.N.R.), University of Chicago Medical Center, Chicago, Illinois michael.rozenfeld@northwestern.edu.
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Rozenfeld
Department of Radiology (S.A.A., A.S., E.J.R., M.C.H.), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Ansari
Department of Radiology (P.M.), University of Miami, Miami, Florida.
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Mohan
Department of Radiology (S.A.A., A.S., E.J.R., M.C.H.), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Shaibani
Department of Radiology (S.A.A., A.S., E.J.R., M.C.H.), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Russell
Department of Radiology (S.A.A., A.S., E.J.R., M.C.H.), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Hurley
D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007297:Inpatients; D002532:Intracranial Aneurysm / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013525:Surgical Instruments; D016896:Treatment Outcome