1238. The Safety of Elective Endovascular Treatment in Unruptured Small Intracranial Aneurysms

Authors: Ahmed J. Awad, MD; Ha Nguyen, MD; Leonardo Batista; Mahmoud Rayes, MD; Justin Sweeney; Johnny Pryor; Raul Nogueira; Andrew Xavier, MD; Rishi Gupta; Italo Linfante; Alexander Norbash; Osama Zaidat (Milwaukee, WI)

Introduction:

The prevalence of intracranial aneurysms has been estimated as 2% in the adult population. Over the last decade, endovascular therapy (EVT) emerged as an effective treatment modality for aneurysms with outcomes comparable with the classic surgical clipping. The goal of this study is to evaluate the safety of EVT in small aneurysms (< 11 mm in maximal diameter)

Methods:

A retrospective multi-center study of safety and clinical outcome following EVT of unruptured small aneurysms at 11 medical centers in the US. Inclusion criteria included elective EVT and small aneurysms < 11 mm in maximal diameter. Peri-procedural complication was defined as thromboembolic event (TEE), rupture within the first 24 hours post-procedure or death within the first 30 days of the procedure.

Results:

A total of 838 patients, harboring 903 aneurysms, were identified. The cohort consisted of 76% females and 76% of Caucasian ethnicity. The incidence of TEE, rupture and death was 3.2%, 2.8% and 0.36%, respectively. Using the logistic regression model, coronary artery disease (CAD) was significantly associated with TEE (p = 0.006), rupture risk (p = 0.006), and all cause of mortality (p = 0.001). The maximal diameter was significantly associated with the rupture risk (p = 0.007). TEE (p = 0.004) and the site of aneurysm (p = 0.048) significantly correlated with the risk of death.

Conclusion:

The endovascular therapy in unruptured small intracranial aneurysms is safe with low rates of complications and mortality. Anterior communicating artery aneurysms were associated with higher complications.