Stroke: Vascular and Interventional Neurology (Nov 2021)
Abstract 1122‐000030: Satellite Model for the Management of Aneurysms to Desaturate the Third Level Health System
Abstract
Introduction: The Centro Medico Nacional 20 de Noviembre is the most complex centre of the Mexican public health system. The SARS COV‐2 pandemic has progressively saturated health services at all levels, impacting chronic non‐communicable diseases 1. Aneurysmal subarachnoid haemorrhage has a mortality rate of up to 35% if not treated 2. Endovascular management of aneurysms provides a therapeutic possibility that shortens the time and reduces complications if implemented in an outpatient system with high standards of patient choice and reduces the chances of complications 3. We present a case series of patients with ruptured and unruptured brain aneurysms treated in a satellite system to reduce in‐hospital days and complications. Methods: A retrospective analysis was carried out of 66 patients admitted on an outpatient basis at the Centro Medico Nacional “20 de noviembre” between May 2020 to June 2021. The patients were entered into a “satellite” system for coils’ endovascular management or flow diverter, previously diagnosed with digital subtracter angiography and computed tomography angiogram. The analysis of variables was done using the Shapiro‐Wilk test to determine the normality of the sample distribution. The correlation of variables was done using Chi‐square. Results: The mean age of the patients was 53.8 years SD 14.31 years. 71.2% of the patients were female, and 28.2% were male. There was a 59.1% left predominance regarding the aneurysm side, 37.9% on the right side, and 3.0% was a single vessel. The arterial predominance was 77.3% anterior circulation. 95.5% of the patients underwent embolization with the placement of coils, and 4.5% had a flow diverter. The mean time of admission was 23.3 hours SD 12.4 hours. Complications occurred in 13.6% of the population studied, the most frequent being vasospasm, arterial occlusion, hydrocephalus, and death from aspiration pneumonia. The modified Rankin scale at 90 days was 0.38 SD 1.13. There was a significant relationship (p = 0.05) between the left side and complications. Conclusions: The management of aneurysms with a short in‐hospital time is a feasible solution in reducing the decongestion of tertiary health systems. Endovascular management with coils results in a low rate of complications, which is why this therapeutic route can be followed to desaturate third‐level health systems and a flow diversion in high well‐selected patients. The relationship between complication rates related to the left side of aneurysms is likely due to the more significant number of aneurysms on this side, not due to anatomical vessel idiosyncrasy.
Keywords
