Background: 20% of strokes are hemorrhagic (HS), with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage each accounting for 10%. Most SAHs are caused by ruptured saccular aneurysms. Therapeutic advances like endovascular coiling (EvC) and clipping have added to the armamentarium for treating this malignant process.
Methods: Data from Nationwide Inpatient Sample (NIS) (years 2003-2013) was analyzed to identify HS (aSAH and ICH) hospitalization using ICD-9-CM codes. EvC and clipping patients were identified from the cohort. A retrospective analysis with multivariate survey logistic regression was done to evaluate the predictors of utilizations of EvC and clipping.
Results: From years 2003 to 2013, total 1,004,736 patients with HS were hospitalized. Out of them, 47,999 (4.7%) patients had EvC and 55,900 (5.6%) patients had clipping. Predictors of higher EvC utilization were young 35-50 years patients (aOR: 1.20; 95%CI: 1.04-1.38), large hospitals (>100 beds) (aOR: 4.53; 95%CI: 3.54-5.81), and urban teaching hospitals (aOR: 4.66; 95%CI: 3.63-5.97). Clipping utilization was higher among age 65-80 years patients (aOR: 2.02; 95%CI: 1.73-2.37) and age >80 years (aOR: 5.15; 95%CI: 4.25-6.23), male (aOR: 2.02; 95%CI: 1.89-2.15), emergency admissions (aOR: 1.73; 95%CI: 1.52-1.97), and pre-existing co-morbidities like renal failure, solid tumor, hypertension, and diabetes. Utilization of EvC was associated with lower frequencies of in poor discharge disposition: transferred to short-term hospital/skilled nursing facility/intermediate care/long term care facility (45.86% vs. 49.75%; p<0.001) in comparison to clipping.
Discussion: Historically, coiling was reserved for the treatment of high-grade subarachnoid bleed, has found to be not only safe but also favourable with better discharge disposition. The recent AHA guideline and multiple research trials have shown the same result.