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

Background 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). Methods 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. Results Our search identified 207198 patients with newly diagnosed UIA (Cohort 1) and 14220 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=47381) 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. Conclusion Among UIA patients, AMD is associated with increased FD utilization and worse clinical outcomes following FD.