Trends in Intervention Modality for Hospitalizations with Infectious Intracranial Aneurysms: A Nationwide Analysis

Abstract Background/Objective Data regarding treatment of infectious intracranial aneurysms most effectively remains sparse. With growing utilization of endovascular therapy for cerebrovascular disease, we examined trends in endovascular versus neurosurgical treatment of infectious aneurysms and investigated the impact of treatment modality on outcomes. Methods Using data from the National Inpatient Sample from 2000 to 2019, we conducted a trends analysis on rates of treatment modalities among hospitalizations with infective endocarditis with ruptured or unruptured cerebral aneurysms. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD-9 and ICD-10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in-hospital mortality and discharge disposition. Results We identified 24,461 hospitalizations with an infectious intracranial aneurysm in the setting of infective endocarditis. Mean age was 56.0 years (SD, 17.8) and 61.8% were male. The overall rate of intervention was 5.8% (95% CI, 5.0-6.5%), and this did not change over time (p=0.669). There was a significant increase in the rate of endovascular repair (APC=3.6%; 95% CI, 1.2%-8.1%) and a significant decrease in the rate of open neurosurgical repair (APC= −5.4%; 95% CI, −8.1% to −3.5%). Treatment modality was not associated with in-hospital mortality (p=0.698) or non-home discharge disposition (p=0.897). Conclusion Although rates of infectious intracranial aneurysm intervention for infective endocarditis did not change, utilization of endovascular treatment increased while the use of open neurosurgical treatment decreased. Further directions include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization. Summary What is already known on this topic - Rates of infective endocarditis and infectious intracranial aneurysms continue to rise, however, there lacks a standard of care in management of this complication. Prior studies have only looked at national trends up until 2011, whereas ours not only analyzes trends up until 2019, but analyzes open neurosurgical and endovascular approaches separately. What this study adds - Our study indicates a significant increase in the use of endovascular treatment with a concomitant significant decrease in open neurosurgical clipping of infectious intracranial aneurysms. While patients undergoing any intervention had better mortality rates than patients treated with medical management alone, we found no statistical difference in mortality rates or disposition between the two treatment modalities. How this study might affect research, practice or policy - Our study highlights the need for further investigation of prognostic factors and timing of intervention in patients with infectious intracranial aneurysms, to standardize management to improve outcomes.