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Abstract
Background Intracranial aneurysm embolization is traditionally performed in a hospital setting, but there is growing interest in transforming these procedures to outpatient facilities, while ensuring patient safety and effectiveness. We present the first series of patients undergoing flow diverting embolization at an ambulatory neurosurgery center (ANSC) and assessed feasibility, safety, and patient satisfaction.
Methods We retrospectively reviewed the medical records of patients undergoing flow diverting embolization at the ANSC between August 1, 2024, and January 3, 2025. Patient demographics, procedural details, and periprocedural events were recorded. Patients were observed at the ANSC before transfer to a rehabilitation facility for overnight monitoring in a simulated home environment. A postprocedural satisfaction survey (scale 0–5; 5=best experience) was completed at the 2 week follow-up.
Results Nine patients (mean age 55±13 years) underwent embolization under conscious sedation. Eight aneurysms in the internal carotid artery (mean aneurysm size 6.3±2.8 mm) and one cervical pseudoaneurysm were treated using the Pipeline Vantage (Medtronic, Dublin, Ireland) via a transfemoral approach. Mean procedural time was 35±1 min; mean turnover time was 17±0.2 min. No periprocedural or delayed complications occurred. Patients were observed for a mean 5.3±1.5 hours in the ANSC and discharged home from rehabilitation on postprocedure day 1. Patient satisfaction was unanimously rated 5.
Conclusions The results showed that flow diverting embolization for aneurysms can be safely and feasibly performed in the outpatient setting with careful patient selection and use of the latest generation flow diverters. An ANSC may offer meaningful benefits, including reducing hospital burden, lower costs, and improvement of overall efficiency, while maintaining patient safety and quality.
- Aneurysm
- Flow Diverter
- Technique
- Technology
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Contributors Conception and design, and analysis and interpretation of the data: PMRL and EIL. Drafting the manuscript: PMRL. Acquisition of the data, revising the manuscript, final approval of the version to be submitted, and accountable for all aspects of the work: all authors. EIL is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests KVS: consulting fees from Boston Scientific, Canon Medical Systems USA, MicroVention, Medtronic, and Stryker Neurovascular; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Canon Medical Systems USA; stock or stock options in Boston Scientific, Access Closure, and Niagara Gorge Medical. EIL: consulting fees from Clarion, GLG Consulting, Guidepoint Global, Medtronic, StimMed, and Mosaic; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Medtronic, Penumbra, MicroVention (now Terumo Neuro), and Integra; patents planned, issued, or pending from Ultrasonic Surgical Blade; participation on a data safety monitoring board or advisory board for NeXtGen Biologics, Cognition Medical, Endostream Medical, and IRRAS AB; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, from CNS, ABNS, and UBNS; stock or stock options (shareholder or ownership interest) in NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, StimMed, Three Rivers Medical, Q’Apel, and Dendrite; other financial or non-financial interests in Haniva Medical Technology (chief medical officer); Medtronic (national PI: steering committees for SWIFT Prime and SWIFT Direct trials; SHIELD trial; site PI: STRATIS Study – Sub I); Penumbra (national PI: THUNDER trial); MicroVention (now Terumo Neuro) (site PI: CONFIDENCE Study).
Provenance and peer review Not commissioned; externally peer reviewed.
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