# Patient Follow-up After Endovascular Treatment of Cerebral Aneurysms: Identifiable Barriers and Implications for Treatment Decisions

## TL;DR

This study finds that patients without insurance and non-English speakers are less likely to attend follow-up visits after cerebral aneurysm treatment, increasing their risk of complications.

## Contribution

The study identifies socioeconomic and demographic barriers to follow-up care after cerebral aneurysm treatment.

## Key findings

- Noninsured patients had significantly fewer follow-up visits and were lost to follow-up more quickly.
- Non–English-speaking patients had fewer follow-up visits and were lost to follow-up more quickly.
- Lack of insurance and non–English-speaking status are significant predictors of poor follow-up.

## Abstract

Cerebral aneurysms are the major cause of spontaneous subarachnoid hemorrhage, and a common treatment is endovascular embolization. Aneurysmal recurrence after embolization is frequent, and clinical follow-up to monitor for this is critical to prevent subarachnoid hemorrhage. Herein, we assess demographic and socioeconomic factors associated with poor clinical follow-up to determine which patients are at high risk of loss to follow-up.

A retrospective analysis was performed of 937 patients who underwent endovascular treatment of cerebral aneurysms at a single center from 2006 to 2017. Attendance at follow-up visits for 5 years after treatment was correlated with various demographic and socioeconomic factors. Follow-up for patients who initially presented with unruptured vs ruptured aneurysms was also compared.

The most significant factors associated with poor follow-up were lack of insurance and non–English-speaking status. Noninsured patients had significantly less follow-up in both mean number of follow-up visits (2.5 ± 1.7 visits for insured patients and 1.0 ± 1.2 visits for noninsured, P < .0001), and in time until lost to follow-up (2.9 ± 1.9 years for insured and 1.1 ± 1.4 years for non-insured, P < .0001). Non–English-speaking patients had less follow-up visits (2.3 ± 1.7 visits for English-speaking and 0.74 ± 1.0 visits for non–English-speaking, P < .0001) and were more quickly lost to follow-up (2.6 ± 1.9 years for English-speaking and 0.82 ± 1.2 years for non–English-speaking, P < .0001).

Demographics and socioeconomic factors, particularly lack of insurance and non–English-speaking status, are correlated with poor clinical follow-up after endovascular treatment of cerebral aneurysms. Patients at high risk of loss to follow-up should be counseled before treatment about risk of aneurysm recurrence.