Krueger Evan M, Farhat Hamad
Neurosurgery, Advocate Aurora Health, Downers Grove, USA.
Cureus. 2022 Jul 31;14(7):e27515. doi: 10.7759/cureus.27515. eCollection 2022 Jul.
Background Elective endovascular treatment (EVT) of unruptured intracranial aneurysms (UIA) is a commonly used treatment modality. However, the appropriate post-procedure management is not well-defined. Methods This was a single-center, retrospective review of all adults undergoing EVT of UIA performed between January 1, 2010, and March 31, 2020. Patients with any current intracranial hemorrhage or clinical symptoms severe enough to warrant emergent intervention were excluded. Results Sixty-seven UIA were treated on 58 patients. The mean dome diameter was 6.6 mm (2-20, ±3.9), the most common parent vessel was the internal carotid artery (43.2%, 29/67), and sole flow diverter stents were the most common device used (46.2%, 31/67). Post-treatment, 43.2% (29/67) patients went to the neurocritical care unit (NCCU). The mean NCCU length of stay (LOS) was 1.07 days (range 1-4, ±0.5), and 96.6% (28/29) only spent one day in the NCCU. There were no (0%, 0/67) anesthesia-related procedural complications. One (1.5%, 1/67) intra-procedural complication was an aneurysm rupture during attempted coiling. There were five (7.4%, 5/67) post-procedural complications: two (3.0%, 2/67) groin hematomas, two (3.0%, 2/67) permanent neurologic events (left lower extremity hypoesthesia and left upper extremity hemiparesis), and one (1.5%, 1/67) temporary neurologic event (aphasia). Post-procedural complications were associated with longer hospital LOS (p=0.02), but not with longer NCCU LOS. No acute management changes occurred for the five patients that developed post-procedural complications. There were no (0%, 0/67) 30-day readmissions. Conclusion The overall incidence of post-procedure complications was low. In the future, a possible viable way to reduce hospital costs may involve utilizing a hospital unit that could closely monitor patients but only for a short period of time post-procedure.
未破裂颅内动脉瘤（UIA）的选择性血管内治疗（EVT）是一种常用的治疗方式。然而，术后的适当管理尚无明确界定。方法：这是一项单中心回顾性研究，纳入了2010年1月1日至2020年3月31日期间接受UIA的EVT治疗的所有成年人。排除当前有任何颅内出血或临床症状严重到需要紧急干预的患者。结果：58例患者共治疗了67个UIA。平均瘤顶直径为6.6毫米（2 - 20，±3.9），最常见的载瘤血管是颈内动脉（43.2%，29/67），最常用的器械是单纯血流导向支架（46.2%，31/67）。治疗后，43.2%（29/67）的患者进入神经重症监护病房（NCCU）。NCCU的平均住院时间（LOS）为1.07天（范围1 - 4，±0.5），96.6%（28/29）的患者仅在NCCU住了一天。没有（0%，0/67）与麻醉相关的手术并发症。1例（1.5%，1/67）术中并发症是在尝试弹簧圈栓塞时动脉瘤破裂。有5例（7.4%，5/67）术后并发症：2例（3.0%，2/67）腹股沟血肿，2例（3.0%，2/67）永久性神经事件（左下肢感觉减退和左上肢偏瘫），1例（1.5%，1/67）短暂性神经事件（失语）。术后并发症与更长的住院LOS相关（p = 0.02），但与更长的NCCU LOS无关。发生术后并发症的5例患者未进行急性管理调整。没有（0%，0/67）30天再入院情况。结论：术后并发症的总体发生率较低。未来，一种可能可行的降低医院成本的方法可能包括利用一个能够密切监测患者但仅在术后短时间内进行监测的医院科室。
