First reported series of intracranial and carotid aneurysm embolization performed at an ambulatory neurosurgery center: preliminary experience.

Abstract

Background: Intracranial aneurysm embolization is traditionally performed in a hospital setting, but there is growing interest in transforming these procedures to outpatient facilities, while ensuring patient safety and effectiveness. We present the first series of patients undergoing flow diverting embolization at an ambulatory neurosurgery center (ANSC) and assessed feasibility, safety, and patient satisfaction.

Methods: We retrospectively reviewed the medical records of patients undergoing flow diverting embolization at the ANSC between August 1, 2024, and January 3, 2025. Patient demographics, procedural details, and periprocedural events were recorded. Patients were observed at the ANSC before transfer to a rehabilitation facility for overnight monitoring in a simulated home environment. A postprocedural satisfaction survey (scale 0-5; 5=best experience) was completed at the 2 week follow-up.

Results: Nine patients (mean age 55±13 years) underwent embolization under conscious sedation. Eight aneurysms in the internal carotid artery (mean aneurysm size 6.3±2.8 mm) and one cervical pseudoaneurysm were treated using the Pipeline Vantage (Medtronic, Dublin, Ireland) via a transfemoral approach. Mean procedural time was 35±1 min; mean turnover time was 17±0.2 min. No periprocedural or delayed complications occurred. Patients were observed for a mean 5.3±1.5 hours in the ANSC and discharged home from rehabilitation on postprocedure day 1. Patient satisfaction was unanimously rated 5.

Conclusions: The results showed that flow diverting embolization for aneurysms can be safely and feasibly performed in the outpatient setting with careful patient selection and use of the latest generation flow diverters. An ANSC may offer meaningful benefits, including reducing hospital burden, lower costs, and improvement of overall efficiency, while maintaining patient safety and quality.