1231. Synergistic outcomes of unruptured intracranial aneurysms: Elimination of treatment bias reduces risk of treatment

Authors: Christopher S. Ogilvy, MD, FAANS; Noah Jordan, BS; Luis Ascanio, MD; Alejandro Enriquez-Marulanda, MD; Mohamed Salem, MD; Ajith Thomas, MD (Boston, MA)

Introduction: The risks of treatment for unruptured intracranial aneurysms is critical in the decision-making process of management. Most reports on treatment-related risks give results for endovascular or surgical management of lesions. This study was performed to better delineate risk estimates for surgical and endovascular treatment (combined synergistic modality management) of patients with unruptured intracranial aneurysms according to a patient’s risk profile with regard to age, aneurysm location, and aneurysm size. Methods: Data was gathered in 553 patients with 658 unruptured intracranial aneurysms that were treated at a single institution between 2014-2017, where the decision to treat was based on a projected morbidity that was lower than the natural history rupture risk. Treating physicians performed both ‘open’ surgical techniques and endovascular treatments. Information on aneurysm size, location, patient age, and outcome at last clinical visit (modified Rankin score-mRS) was collected and analyzed retrospectively. Results: The mean patient age was 59 years, the mean lesion size was 7.3 millimeters. Microsurgical clipping was used in 251 (38.2%) of lesions, endovascular coiling in 70 (10.6%), stent-assisted coiling in 89 (13.5%) and Pipeline embolization device in 248 (37.7%). Complications from procedures or during hospital admission occurred in the treatment of 66 (10% of total) lesions. Twenty-eight (4.32% of total) of these complications were non-neurologic and were treated with no permanent morbidity. Neurologic complications occurred in 38 procedures (5.7% of total). Of these, 7 (1%) resulted in a permanent poor outcome, with an mRS 3-6. Conclusion: Using endovascular and surgical obliteration in synergy, low risks of treatment can be achieved for unruptured aneurysms. With lower overall risks, treatment can be considered in smaller aneurysms and older patients who are carefully selected.