Moderated Poster Australian and New Zealand Stroke Organisation Conference 2025

Persistent neurological deficit after elective repair of unruptured intracranial aneurysms: associations and impact on functional recovery (123327)

Ronil Chandra 1 2 , Fergus Taylor 1 , Evan Urquhart 1 , Katherine Vuong 1 , Hilary Madder 3 4 , Wei-Yun Mak 5 , Lachlan Dalli 6 , Leon Lai 4 7 , Thanh Phan 6 8 , Seana Gall 9
  1. Neurointerventional Radiology , Monash Medical Centre, Monash Health , Melbourne , Victoria, Australia
  2. Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
  3. Department of Anaesthesia , Monash Health, Melbourne, Victoria, Australia
  4. Department of Surgery, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
  5. Department of Intensive Care, Monash Health, Melbourne, Victoria, Australia
  6. Department of Medicine, School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
  7. Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
  8. Department of Neurology, Monash Medical Centre, Monash Health , Melbourne, Victoria, Australia
  9. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

Background/Aims:

Persistent neurological deficit (PND) after elective repair of unruptured intracranial aneurysms (UIAs) may affect a patient’s ability to return home and maintain independence. We evaluated the incidence and factors associated with PND following elective UIA repair. 

Methods:

Retrospective cohort study at a high-volume neurovascular centre in Melbourne, Australia. Adults (≥18-years) admitted for elective repair of saccular UIAs between July 2010 and June 2024 were included. Data sources included clinical, radiological and administrative records. PND was defined as new post-procedural neurological deficit lasting >24-hours. Outcomes were discharge destination and 30-day mortality. Multivariable logistic regression identified factors associated with PND, reported as adjusted odds ratios (aORs) with 95% confidence intervals(95%CIs). 

Results:

A total of 520 patients underwent 602 elective UIA repairs (77% female, median age 57-years, IQR 50-66). Comorbidities included prior stroke (24%), ischemic heart disease (7%), cancer history (10%). Median aneurysm size was 6mm (IQR 4–8mm); 53% underwent neurosurgical clipping, 47% endovascular treatment. PND occurred after 76 (13%) procedures, with persistence at discharge after 6%. PND was associated with longer procedures (235 vs 195 minutes,p<0.001), intra-procedural rupture (aOR1.62, 95%CI 1.24-2.10,p<0.001), posterior circulation UIAs (aOR1.16, 95%CI 1.05-1.28,p=0.004) and symptomatic UIAs (aOR1.10, 95%CI 1.03-1.17,p=0.003). PND was associated with longer admission (median:5 vs 3 days,p<0.001), reduced independent mobility at discharge (87% vs 99%,p<0.001), lower discharge home (74% vs 98%,p<0.001) and 30-day mortality (3% vs 0%, p=0.015).

Conclusion:   

PND is uncommon but associated with aneurysm characteristics and procedural factors. Occurrence was associated with poorer short-term functional outcome, supporting use as a patient-centred quality metric.