Beydoun Hind A, Beydoun May, Zonderman Alan, Eid Shaker M
Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, USA.
Intramural Research Program, National Institute on Aging, Baltimore, USA.
Cureus. 2020 Apr 12;12(4):e7645. doi: 10.7759/cureus.7645.
Ischemic stroke among hospitalized patients who underwent surgical or endovascular therapies for unruptured intracranial aneurysms (IAs) has not been previously examined in nationally representative samples.
The purpose of this study is to compare the occurrence and in-hospital outcomes (nonroutine discharge, length of stay) of perioperative ischemic stroke among hospitalized patients diagnosed with unruptured IA across treatment selection [surgical clipping, endovascular coiling, stent- or balloon-assisted coiling (SAC or BAC), combined clipping and coiling].
A cross-sectional study was conducted using 23,053 hospital discharge records from the 2002-2012 Nationwide Inpatient Sample (NIS). Rates, β coefficients, and odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated accounting for survey design complexity, patient- and hospital-level confounders.
Ischemic stroke rate was 6.9% [surgical clipping (4.3%), endovascular coiling (8.1%), BAC or SAC (1.9%), and combined techniques (4.2%)]. Multivariable logistic regression models suggested that compared to patients undergoing surgical clipping alone, those undergoing SAC or BAC were less likely to be diagnosed with ischemic stroke (adjusted OR=0.34, 95% CI: 0.14, 0.85). Compared to clipping, endovascular techniques resulted in fewer nonroutine dispositions and shorter hospitalizations, whereas combined techniques resulted in longer hospitalizations. Differences in hospitalization outcomes between treatment types were only affected by ischemic stroke when comparing coiling to clipping.
Perioperative ischemic stroke rate among patients with unruptured IA may be less among those undergoing SAC or BAC as compared to those undergoing surgical clipping alone. Improved in-hospital outcomes among coiling versus clipping recipients may depend on ischemic stroke diagnosis.
既往尚未在具有全国代表性的样本中研究接受未破裂颅内动脉瘤（IA）手术或血管内治疗的住院患者的缺血性卒中情况。
本研究旨在比较诊断为未破裂IA的住院患者在不同治疗选择（手术夹闭、血管内栓塞、支架或球囊辅助栓塞[SAC或BAC]、联合夹闭和栓塞）下围手术期缺血性卒中的发生率及住院结局（非常规出院、住院时间）。
利用2002 - 2012年全国住院患者样本（NIS）中的23,053份医院出院记录进行横断面研究。考虑到调查设计的复杂性、患者和医院层面的混杂因素，计算了发生率、β系数和比值比（OR）及其95%置信区间（CI）。
缺血性卒中发生率为6.9%[手术夹闭（4.3%）、血管内栓塞（8.1%）、BAC或SAC（1.9%）、联合技术（4.2%）]。多变量逻辑回归模型表明，与仅接受手术夹闭的患者相比，接受SAC或BAC的患者被诊断为缺血性卒中的可能性较小（调整后OR = 0.34，95%CI：0.14，0.85）。与夹闭相比，血管内技术导致的非常规出院较少且住院时间较短，而联合技术导致住院时间较长。在比较栓塞与夹闭时，治疗类型之间的住院结局差异仅受缺血性卒中影响。
与仅接受手术夹闭的患者相比，接受SAC或BAC的未破裂IA患者围手术期缺血性卒中发生率可能较低。栓塞与夹闭患者住院结局的改善可能取决于缺血性卒中的诊断。
