|| Checking for direct PDF access through Ovid
Introduction: The decision for active intervention for unruptured intracranial aneurysm patients are challenging due to most unruptured intracranial aneurysm patients are asymptomatic and they are reasonably healthy, but the procedure related risks such as stroke and mortality cannot be ignored. Selected high volume centers’ outcomes can potentially mislead the decision making process. Thus we aim to review the real-world clinical outcome of unruptured intracranial aneurysm treatment through a large national database.Methods: Unruptured intracranial aneurysm patients (18 to 86 years) from the 2007 to 2013 National Inpatient Sample Data were analyzed. Clinical outcomes evaluated include mortality, stroke, combined mortality and stroke, discharge home rate and complications except for mortality and stroke (M&S). Comparison of clinical outcomes between coiling and clipping were made through multivariate logistic regression and propensity-score matching. Also, hospital volume effects and over time trend of clinical outcomes per each intervention were analyzed.Results: Among 54,202 unruptured intracranial aneurysm patients, 37,050 (68.3%) were not treated, and either clipping or coiling was performed in 17,077 (31.5%). 6,120 (35.8%) patients had clipping and coiling was performed in 10,957 (64.16%). Unadjusted overall mortality, stroke, discharge home rate and complications except M&S were 0.5%, 3.27%, 2.2%, 84.24% and 11.05%, respectively. Coiling was favored for stroke and discharge home rate (p<0.05). Mortality rate was favored clipping but not statistically significant (p>0.05). Complications except M&S favored clipping and was statistically significant (p<0.05). Increasing hospital volume showed higher discharge home rate for both coiling (p=0.032) and clipping (p=0.000), and decreased mortality (p=0.009) in coiling. From 2007 to 2013, stroke rates showed statistically significantly reduced over time on clipping cohort.Conclusion: Active interventions on unruptured intracranial aneurysm showed very low overall mortality. However, coiling showed lower stroke rate and higher home discharge rate than clipping. There was no significant difference in mortality between coiling and clipping.