• Amer Alshekhlee, Sonal Mehta, Randall C Edgell, Nirav Vora, Eli Feen, Afshin Mohammadi, Sushant P Kale, and Salvador Cruz-Flores.
• Department of Neurology, St. Louis University, St. Louis, MO 63104, USA. aalshekh@slu.edu
• Stroke. 2010 Jul 1;41(7):1471-6.

Background And PurposeTo determine the hospital mortality rates associated with elective surgical clipping and endovascular coiling of unruptured intracranial aneurysms.MethodsWe identified a cohort of patients electively admitted to US hospitals with the diagnosis of unruptured intracranial aneurysm from the National Inpatient Sample database for the years 2000 through 2006. Patient demographics, hospital-associated complications, and in-hospital mortality were compared among the treatment groups. A multivariate logistic regression analysis was used to identify independent variables associated with hospital mortality. Cochrane-Armitage test was used to assess the trend of hospital use of these procedures.ResultsAfter data cleansing, 3738 (34.3%) patients had aneurysm clipping and 3498 (32.1%) had endovascular coiling. The basic demographics including age, race, and comorbidity indices were similar between the groups. The length of hospital stay was longer in the clipped population (median 4 versus 1 day; P<0.0001), incurring a higher hospital charge in the coiled population (median $42 070 versus $38 166; P<0.0001). Hospital mortality was higher in the clipped population: 60 (1.6%) versus 20 (0.57%; adjusted odds ratio 3.63; 95% CI, 1.57, 8.42). Perioperative intracerebral hemorrhage and acute ischemic stroke were higher in the clipped population. The rate of hospital use of the endovascular coiling has increased over the years included in this study (<0.0001).ConclusionsElective coiling of unruptured intracranial aneurysms is associated with fewer deaths and perioperative complications compared with elective clipping. The trend of hospital use of the coiling procedures has increased during recent years.

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