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The primary treatment modality was surgical in 2,357 cases and endovascular in 255 cases. Adverse outcomes were significantly more common in surgical cases (18.5%) compared to endovascular cases (10.6%) (p = 0.002), and the difference was not altered after adjusting for age, sex, race, transfer admissions, emergency room admissions, and year of treatment (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.4 to 3.3; p = 0.001). In-hospital mortality was also increased in surgical cases (2 .3% versus 0.4%; p = 0.039), but the difference was not significant in the multivariable model (OR 6.3, 95% CI 0.9 to 46.1; p = 0.07). Length of stay and hospital charges were significantly greater for surgical cases (p < 0.0001 for each), and these diff erences were not affected by risk adjustment. Endovascular coil embolization resulted in fewer adverse outcomes than surgery for unruptured cerebral aneurysms treated at the university hospitals studied. Although these results should be seen as prelimin ary, the magnitude of difference and current predominance of surgery appear to justify a randomized trial. |
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aneurysm
aneurysm,intracranial
aneurysm,intracranial,treatment of
aneurysm,unruptured
cost effectiveness
embolization,therapeutic
embolization,therapeutic,coils
endovascular therapy
iatrogenic neurologic disorders
mortality
neurologic complications of,surgery
neuroradiology,interventional
treatment of neurologic disorder
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