Abstract 128: Outcomes of Intervention versus Medical Management Alone for Infectious Intracranial Aneurysms ‐ A Nationwide Analysis

Introduction Infectious intracranial aneurysms (IIA) are one of several cerebrovascular complications associated with infective endocarditis (IE). IIA are initially treated with antibiotics given that treatment of the underlying infection is an important component of therapy. However, given the complex nature of these aneurysms, a multi‐disciplinary approach may be warranted for optimal outcomes, which includes coiling, embolization, clipping, or a combination of these measures. Herein, we aim to better understand outcomes in the use of medical management alone in this group of patients versus additional interventions. Methods Using data from the National Inpatient Sample from 2000 to 2020, we conducted an analysis comparing outcomes of intervention with medical management versus medical management alone for hospitalizations with infective endocarditis. A subgroup analysis of ruptured vs unruptured aneurysms was performed with primary endpoints being mortality and favorable outcome defined as discharge disposition to home without services. Treatment modalities were categorized as antibiotics, endovascular, and/or 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, while accounting for age and illness severity [quantified by All Patient Refined Diagnostic Related Groups (APR‐DRG) illness severity subclass]. Effect size was reported as adjusted odds ratio (aOR) with 95% confidence interval (CI). Results This analysis identified 2711 hospitalizations for IE, of which 315 (11.6%) were treated with antibiotics alone, versus 2715 (88.4%) which were treated with both antibiotics and intervention. IE patients undergoing intervention experienced significantly decreased mortality rates in comparison to those receiving antibiotics alone (6.3% v 9.9%; p =0.045), however rates of favorable outcomes did not differ (22.5% vs. 25.0%, p=0.343). In sub‐group analysis of ruptured IIA (n=633, 23.4% of total cohort), intervention yielded significantly lower mortality rates (10.6% v 24.8%, p<0.001) and a trend toward increased rates of favorable outcomes (14.3% v 9.1%, p=0.077). In sub‐group analysis of unruptured IIA, intervention resulted in lower absolute mortality rates (2.9% v 6.0%, p=.088) but no difference in favorable outcomes (28.9% v 29.1, p=0.957). Conclusion While treatment of IIA often involves a multidisciplinary approach, antibiotics as part of medical management remains integral. Our study showed that intervention in addition to medical management led to decreased mortality rates, especially in patients with ruptured IIA. Further directions for future studies include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.