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

Data regarding the optimal treatment of infectious intracranial aneurysms 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.

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.

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).

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 without adverse effects on mortality rate. Further directions include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.