{
  "abstract": "Introduction Flow-diverter (FD) stents are increasingly used in aneurysmal subarachnoid hemorrhage (aSAH), but real-world outcomes compared with conventional coiling remain uncertain. We evaluated national treatment patterns and in-hospital mortality associated with FD-based therapy in patients hospitalized with ruptured aneurysms.Methods Using the 2018-2022 National Inpatient Sample, we identified adult hospitalizations with a principal diagnosis of intracranial aneurysm and nontraumatic subarachnoid hemorrhage who underwent surgical clipping, coil embolization, or FD-based therapy. For the primary comparison, endovascularly treated patients were divided into coil-only and FD ± coil groups. The primary outcome was in-hospital mortality. Survey-weighted logistic regression was used with sequential adjustment for demographics, socioeconomic variables, illness severity, hospital characteristics, and treatment era. A separate model identified factors associated with receiving FD ± coil rather than coil-only.Results Weighted national estimates showed 8,265 patients treated with coil-only and 5,665 treated with FD ± coil. Crude in-hospital mortality was higher with FD ± coil overall (21.5% vs 14.3%) and across all eras: 2018-2019, 20.2% vs 14.0%; 2020, 23.1% vs 14.5%; 2021-2022, 22.0% vs 14.7%. After adjustment for age and sex, FD ± coil was associated with higher odds of in-hospital death (aOR 1.28, 95% CI 1.04-1.58, p=0.02). After additional adjustment for race/ethnicity, payer, income, severity, mortality risk, weekend admission, and hospital factors, this association was no longer significant (aOR 0.90, 95% CI 0.72-1.12, p=0.35). In the fully adjusted model including era and hospital ownership, there was no mortality difference between groups (aOR 1.00, 95% CI 0.81-1.25, p=0.98). Older age (aOR 1.05 per year, 95% CI 1.04-1.06, p<0.001) and private insurance (aOR 1.41, 95% CI 1.03-1.93, p=0.033) predicted FD use. FD use was less common pre-COVID than in 2021-2022 (aOR 0.65, 95% CI 0.53-0.79, p<0.001).Conclusion In patients with aneurysmal, nontraumatic SAH treated with clipping, coiling, or FD-based strategies, FD ± coil was associated with higher crude but not adjusted mortality, suggesting that differences in case mix and severity, rather than treatment itself, explain the unadjusted mortality gap.Disclosures K. Gupta: None. M. Karsy: None. D. Altschul: None.Abstract E-280 Table 1Key findings comparing FD ± coil versus coil-only in endovascularly treated aSAH (NIS 2018-2022)",
  "authors": [
    {
      "affiliations": [
        "The Leo M. Davidoff Department of Neurological Surgery Team, Albert Einstein School of Medicine, Bronx, NY"
      ],
      "name": "K Gupta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Michigan, Lansing, MI"
      ],
      "name": "M Karsy"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Florida, Gainesville, FL"
      ],
      "name": "B Lucke-Wold"
    },
    {
      "affiliations": [
        "The Leo M. Davidoff Department of Neurological Surgery Team, Albert Einstein School of Medicine, Bronx, NY"
      ],
      "name": "D Altschul"
    }
  ],
  "title": "E-280 Flow-diverter-based versus coil-only treatment in aneurysmal subarachnoid hemorrhage: a national inpatient sample analysis, 2018-2022",
  "uid": "257b82ee-7ac3-596f-81af-b4815bac592d"
}