Real-World Data from the First Intracranial Aneurysm Cohort in the Eastern Caribbean from 2021 to 2024: The Population Characteristics, Treatment Outcomes, and Effectiveness of the Newly Established Regional Organization with Air Transfer to the First Tertiary Neurointerventional Center in the Eastern Caribbean.

The establishment of the first tertiary Neurointerventional Center at the University Hospital of Martinique in 2021, with full coverage of the populations of the French Antilles and Guyana, represents a paradigm shift in the treatment of intracranial aneurysms in the eastern Caribbean. We sought to evaluate the outcomes of the first cohort of patients treated for intracranial aneurysms from 2021 to 2024. We analyzed demographic, clinical, and angiographic data from a prospectively maintained database of patients treated from 1 January 2021 to 31 March 2024. The primary endpoint was the clinical outcome (mRS at discharge and at 4-6 months), and the secondary endpoint was the angiographic outcomes. One hundred patients (mean age 56.7 ± 12.2 years old) with a total of 125 aneurysms (60.8% ruptured; 39.2% unruptured) were included from the following regions: 60% from Martinique, 21% from Guadeloupe, 13% from French Guyana, 1% from mainland France, 2% from St Martin, and 3% from abroad. The mean initial GCS value was 11.6 (median: 13; min: 4; max: 15); the mean mRS was 1.8 ± 1.7 before intervention, 1.8 ± 2 at discharge, and 1.7 ± 2 at 4-6 months. A total of 75% of the aneurysms were treated with coiling or remodeling, 23% received stents (20% FDs), and 0.8% were treated surgically. The procedure-related morbidity rate was 5.6% (7/125), and the mortality rate was 10.4%; both these percentages concerned only the ruptured cases. In the ruptured aneurysm subgroup, 32.8% (25/76) of complications were SAH-related, 9.2% (7/76) were hydrocephalus incidences, and 23.6% (18/76) were vasospasm cases. Satisfactory occlusion was obtained for 95.2% of the aneurysms post-procedure and for 96.7% at the last angiographic control. At the six-month control, 68% of the patients were independent in their everyday lives (mRS ≤ 2). The population was distinct in terms of the hyperexpression of risk factors, the multiplicity of IAs, and the severity of SAH. Female predominance was higher than usual in the population (81%). The organizational schema seemed effective; the treatments were safe and effective in terms of the clinical and angiographic outcomes.