Clinical Utility of Routine Postprocedural Computed Tomography of the Head Following Elective Neuroendovascular Interventions

Guilherme Barros; R Michael Meyer; David I Bass; Dominic Nistal; Malia McAvoy; Julian V Clarke; Kevin N Vanent; Michael J Cruz; Michael R Levitt

doi:10.1016/j.wneu.2022.09.059

Clinical Utility of Routine Postprocedural Computed Tomography of the Head Following Elective Neuroendovascular Interventions

World Neurosurg. 2022 Nov:167:e1426-e1431. doi: 10.1016/j.wneu.2022.09.059. Epub 2022 Sep 17.

Authors

Guilherme Barros¹, R Michael Meyer¹, David I Bass¹, Dominic Nistal¹, Malia McAvoy¹, Julian V Clarke¹, Kevin N Vanent², Michael J Cruz¹, Michael R Levitt³

Affiliations

¹ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
² School of Medicine, University of Washington, Seattle, Washington, USA.
³ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA; Department of Radiology, University of Washington, Seattle, Washington, USA; Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA; Stroke & Applied Neurosciences Center, University of Washington, Seattle, Washington, USA. Electronic address: mlevitt@uw.edu.

PMID: 36122855
DOI: 10.1016/j.wneu.2022.09.059

Abstract

Background: Little evidence supports acquisition of routine head imaging after uncomplicated elective neurosurgical procedures for patients with unchanged neurological examinations; however, imaging is still performed by some neurointerventionalists. We assessed the clinical utility of routine computed tomography of the head (CTH) following elective neuroendovascular interventions, including aneurysm coiling, aneurysm stent-assisted coiling, aneurysm flow diversion, arteriovenous malformation/fistula embolization, middle meningeal artery embolization for subdural hematoma, extracranial carotid artery stenting, and venous sinus stenting.

Methods: Retrospective chart review identified patients undergoing neuroendovascular intervention from 2011 to 2021 at our institution. Demographic, clinical, and radiographic variables, including presenting signs and symptoms, antiplatelets and/or anticoagulant medications, intraprocedural complications, postprocedural CTH findings, and postprocedural neurological examinations, were recorded. Association of clinical variables with an abnormal postprocedural CTH was assessed with univariate analysis. Patients with ruptured vascular pathology, preoperative embolizations, and missing postprocedural CTH images and/or reports were excluded.

Results: Of 509 procedures identified, 354 were eligible for analysis; 4.8% of patients (17/354) had abnormal findings on postprocedural CTH. Nine patients had intraprocedural complications or new postprocedural neurological deficits that would have prompted imaging regardless of institutional practice. None of the remaining 8 (2.3%) patients required additional procedures. New postprocedural neurological deficit was the only significant predictor of abnormal postprocedural CTH (odds ratio = 6.79; 95% confidence interval, 2.01-20.32; P = 0.0009).

Conclusions: In a large cohort of patients undergoing elective neuroendovascular intervention, no patients were identified for whom routine postprocedural CTH alone meaningfully altered their clinical care. Routine CTH is not necessary after uncomplicated elective neuroendovascular interventions performed with careful postprocedural neurological assessment.

Keywords: CT head; Computed tomography; Neuroendovascular; Neurointerventional; Postoperative imaging; Postprocedural imaging; Routine imaging.

MeSH terms

Aneurysm*
Arteriovenous Fistula*
Carotid Stenosis*
Endovascular Procedures* / methods
Humans
Retrospective Studies
Stents
Tomography, X-Ray Computed