AMBULATORY MANAGEMENT OF INTRACRANIAL ANEURYSMS EMBOLIZATION SAFETY AND EFFICACY ASSESSMENT

Intracranial aneurysms are widely treated using mini-invasive endovascular treatment. Recent development of radial artery access has dramatically reduced puncture site complications and exclusive intrasaccular occlusion is associated with the lowest rate of neurovascular post-operative events. Chronological analysis of neurovascular events after aneurysms coiling suggests that events no longer appear after first post operative hours suggesting that prolonged surveillance may not be needed. We analyzed safety and radiological efficacy of ambulatory management in patients presenting intracranial aneurysms treated by intrasaccular occlusion.

We retrospectively analyzed a cohort of 21 consecutive patients (25 aneurysms). All cases have been treated using outpatient management workflow after pre-operative 3D DSA selection and anesthetic consultation validating strict intrasaccular treatment (coiling ± balloon remodeling or intrasaccular flow disruptor) and patient condition compatible with ambulatory care. Endovascular procedures were systematically performed through radial artery access. All cases were hospitalized in a dedicated ambulatory environment with specific surveillance. Safety data and angiographic efficacy were analyzed from treatment to latest follow up available.

No early significant clinical events were observed. 2 radial artery asymptomatic occlusions occurred. Mean hospital stay was 11h27min and mean procedural duration was 41 minutes. 16/17 of controlled cases were adequately occluded at 6 months (mRROC I-II ) and 12/12 at 12 months.

Ambulatory management is feasible and efficient in our population of selected cases treated by elective intrasaccular procedures. These findings suggest that outpatient management could be extended in a larger population of selected unruptured aneurysms using transradial approach and elective intrasaccular occlusion. A dedicated surveillance in a specific facility is mandatory to warrant high level of safety.