title: Is intensive care monitoring necessary after coil embolization of unruptured intracranial aneurysms?
abstract: BACKGROUND
  Patients with an unruptured intracranial aneurysm treated with coil embolization are routinely admitted to the intensive care unit (ICU) after the procedure; however, this practice is questionable. The purpose of this study was to determine if routine admission to the ICU is necessary for patients undergoing coil embolization of an unruptured intracranial aneurysm.
  
  
  METHODS
  We conducted a retrospective cohort study of all patients undergoing elective endovascular treatment of an unruptured intracranial aneurysm between 2005 and 2012 at our institution. Multivariate regression analysis was performed to identify predictors of outcome. Cost savings analysis compared ICU admission to step-down or telemetry unit admission.
  
  
  RESULTS
  311 unruptured intracranial aneurysms were treated by coil embolization (190), balloon remodeling (13), or stent-assisted coiling (108). Eleven (3.5%) neurologic complications were noted; 5 (1.6%) of these were permanent. Multivariate regression analysis identified female sex (p=0.028), hypercoagulability (p=0.021), aneurysm size >2 cm (p=0.003), and intraoperative rupture (p<0.001) as predictors of a post-procedural neurologic complication. Cost savings were 57% for admission to a step-down unit and 32% for admission to a telemetry unit compared with ICU admission.
  
  
  CONCLUSIONS
  Neurologic complications are rare in the treatment of unruptured intracranial aneurysms, suggesting that routine ICU admission after treatment may not be necessary. Female sex, history of hypercoagulability, aneurysm size >2 cm, and an intraprocedural rupture were predictive of a postoperative complication. ICU monitoring in these subgroups may therefore be warranted.
authors.affiliation: Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.affiliation: Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Julius
authors.initials: J
authors.lastname: Griauzde
authors.affiliation: Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Yamaan
authors.initials: Y
authors.lastname: Saadeh
authors.affiliation: Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Wajd N
authors.initials: WN
authors.lastname: Al-Holou
authors.affiliation: Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA.|Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.affiliation: Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA.|Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.affiliation: Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA.|Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.affiliation: Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA.|Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.|Departments of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000639:trends*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000639:trends*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000639:trends; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000639:trends*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000639:trends; D055815:Young Adult
keywords: Aneurysm; Coil