Impact of anxiety and mood disorders on elective flow diversion for unruptured intracranial aneurysms: propensity score-matched analyses of two large databases.

Patients with anxiety and mood disorders undergoing elective flow diversion for unruptured intracranial aneurysms may experience higher treatment rates and worse outcomes compared to those without these disorders.

Summary and findings

This study examined the impact of anxiety and mood disorders (AMD) on the management and outcomes of patients with unruptured intracranial aneurysms (UIAs). It analyzed data from two cohorts: newly diagnosed UIA patients and those who underwent elective flow diversion (FD). The findings indicated that patients with AMD had higher rates of FD treatment and worse clinical outcomes compared to non-AMD controls.

Abstract

<h4>Background</h4>Anxiety and mood disorders (AMD) may impact the management and outcomes of patients with unruptured intracranial aneurysms (UIAs). This study investigates AMD's associations with utilization and outcomes of endovascular flow diversion (FD).<h4>Methods</h4>This was a retrospective analysis of two databases - TriNetX and Nationwide Readmissions Database (NRD, 2020-2022). Patients with newly diagnosed UIA (Cohort 1, TriNetX) and those who underwent elective FD (Cohort 2, NRD) were identified and grouped into AMD and non-AMD controls; 1-to-1 propensity score matching (PSM) was performed to balance groups based on demographics and comorbidities. FD treatment rates within 5 years of UIA diagnosis (Cohort 1) and post-procedure outcomes of elective FD treatments (Cohort 2), including morbidity/mortality (discharge to rehabilitation/death) and stroke, were compared between AMD vs PSM controls.<h4>Results</h4>Our search identified 207 198 patients with newly diagnosed UIA (Cohort 1) and 14 220 who underwent elective FD (Cohort 2); ~30% of patients had AMD in both cohorts. In Cohort 1, patients with AMD with newly diagnosed UIA (n=47 381) had significantly higher rates of FD treatment compared with PSM controls (1.9% vs 1.5%, hazard ratio (HR) 1.23 (95% confidence interval (CI) 1.10 to 1.37) p<0.001). In Cohort 2, patients with AMD who underwent elective FD (n=3832) exhibited higher rates of perioperative morbidity/mortality (8.0% vs 4.8%; odds ratio (OR) 1.73 (95% CI 1.23 to 2.44), p=0.002), post-discharge morbidity/mortality (HR 1.63 (95% CI 1.11 to 2.40), p=0.012), perioperative stroke (6.7% vs 4.7%; OR 1.44 (95% CI 1.06 to 1.95), p=0.021), and post-discharge stroke (HR 1.82 (95% CI 1.05 to 3.17), p=0.034) compared with PSM controls.<h4>Conclusion</h4>Among UIA patients, AMD is associated with increased FD utilization and worse clinical outcomes following FD.

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