Current status and prospects of ambulatory surgery model for neurovascular interventions_West China Medical Journal

Authors：

ZHANG Zhiyong ¹ , LIU Xinyu ¹ ,  NI Ruyang ²

1. Department of Neurology, Beijing Geriatric Hospital, Beijing 100095, P. R. China;
2. Hospital Office, Beijing Geriatric Hospital, Beijing 100095, P. R. China;

Corresponding author：

NI Ruyang, Email: niruyang@126.com

Keywords：

Ambulatory surgery; neurovascular intervention; cerebral angiography; aneurysm; chronic subdural hematoma

DOI：

10.7507/1002-0179.202601058

Video：

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Neurovascular interventional technology serves as a crucial means for the diagnosis and treatment of cerebrovascular diseases. The ambulatory surgery model, characterized by its efficiency and minimally invasive nature, has been widely adopted across multiple clinical specialties. However, its development in the field of neurovascular interventions remains at an early exploratory stage. This article systematically reviews the current status of the ambulatory surgery model for neurovascular interventions and provides insights into future research directions and development pathways, aiming to provide references for promoting the safe, standardized, and large-scale implementation in ambulatory surgery model for neurovascular interventions.

1.	Dawkins AA, Evans AL, Wattam J, et al. Complications of cerebral angiography: a prospective analysis of 2, 924 consecutive procedures. Neuroradiology, 2007, 49(9): 753-759.
2.	Scullen TA, Lian MX, Jaikumar V, et al. First reported series of cerebral angiography performed at an outpatient center: safety and satisfaction results. Neurosurgery, 2025, 96(3): 539-544.
3.	于丽华. 中国日间手术发展的历程与展望. 中国医院管理, 2016, 36(6): 16-18.
4.	Preece R, Stenson K, Shaw S, et al. Recent developments and current controversies in short-stay endovascular aneurysm repair. J Cardiovasc Surg (Torino), 2019, 60(4): 460-467.
5.	国家老年疾病临床医学研究中心(湘雅医院), 国家科技部内镜微创技术装备与标准国际联合研究中心. 综合医院日间手术室运行和管理中国专家共识(2022 版). 中华消化外科杂志, 2022, 21(9): 1173-1179.
6.	Taxiarchi P, Kontopantelis E, Martin GP, et al. Same-day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. JACC Cardiovasc Interv, 2019, 12(15): 1479-1494.
7.	Lai PMR, DeGaetano AC, Levy EI. Cerebral angiography in outpatient endovascular centers: roadmap and lessons learned from interventional radiology, cardiology, and vascular surgery. J Neurointerv Surg, 2025, 17(8): 907-908.
8.	Agarwal S, Thakkar B, Skelding KA, et al. Trends and outcomes after same-day discharge after percutaneous coronary interventions. Circ Cardiovasc Qual Outcomes, 2017, 10(8): e003936.
9.	Doby T. Cerebral angiography and Egas Moniz. AJR Am J Roentgenol, 1992, 159(2): 364.
10.	段传志, 李铁林. 神经介入放射学的发展现状及未来展望. 中华神经医学杂志, 2025, 24(1): 2-7.
11.	郭德华, 孔令华, 白卫星, 等. 脑血管介入手术机器人的研究进展. 中华放射学杂志, 2021, 55(6): 682-686.
12.	Fifi JT, Meyers PM, Lavine SD, et al. Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol, 2009, 20(4): 442-447.
13.	Qureshi AI, Naseem N, Saleem MA, et al. Migraine and non-migraine headaches following diagnostic catheter-based cerebral angiography. Headache, 2018, 58(8): 1219-1224.
14.	Cho SM, Deshpande A, Pasupuleti V, et al. Radiographic and clinical brain infarcts in cardiac and diagnostic procedures: a systematic review and meta-analysis. Stroke, 2017, 48(10): 2753-2759.
15.	Lapow JM, Pammal RS, Brozynski M, et al. Complication rates following cerebral and coronary angiography: nationwide analysis 2008-2014. Cardiol Rev, 2024, 32(6): 507-512.
16.	Rai AT, Domico J. Routine pre-procedure laboratory testing for patients undergoing outpatient cerebral angiography is not indicated. J Neurointerv Surg, 2013, 5(2): 172-176.
17.	Jeong YG, Kim EH, Hwang SM, et al. Outpatient (same-day care) neuroangiography and neurointervention. Neurointervention, 2012, 7(1): 17-22.
18.	Liu H, Park D, Hwang SM, et al. Outpatient day-care neuroangiography and neurointervention of unruptured intracranial aneurysms. Neurointervention, 2016, 11(1): 37-41.
19.	Behrens L, Adam A, Rubeck A, et al. Safety aspects and procedural characteristics of ambulatory diagnostic cerebral catheter angiography. Clin Neuroradiol, 2024, 34(1): 155-162.
20.	Razavi SM, Masangkay E, Chelikam N, et al. Safety of cerebral angiography in private outpatient clinical setting. Ann Neurol, 2020, 88: S169-S169.
21.	Heyde GS, Koch KT, de Winter RJ, et al. Randomized trial comparing same-day discharge with overnight hospital stay after percutaneous coronary intervention: results of the Elective PCI in Outpatient Study (EPOS). Circulation, 2007, 115(17): 2299-2306.
22.	Brayton KM, Patel VG, Stave C, et al. Same-day discharge after percutaneous coronary intervention: a meta-analysis. J Am Coll Cardiol, 2013, 62(4): 275-285.
23.	Rao SV, Kaltenbach LA, Weintraub WS, et al. Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients. JAMA, 2011, 306(13): 1461-1467.
24.	Hyasat K, Femia G, Alzuhairi K, et al. Safety, feasibility and economic analysis of same day discharge following elective percutaneous coronary intervention. Clin Med Insights Cardiol, 2022, 16: 11795468221116852.
25.	Brown CS, Smith ME, Kim GY, et al. Exploring the rapid expansion of office-based laboratories and peripheral vascular interventions across the United States. J Vasc Surg, 2021, 74(3): 997-1005.e1.
26.	Goland J, Doroszuk G, Ypa P, et al. Outpatient treatment of cerebral aneurysms: a case series. Surg Neurol Int, 2020, 11: 400.
27.	Suh DC, Choi YH, Park SI, et al. Outpatient day-care management of unruptured intracranial aneurysm: a retrospective cohort study. Korean J Radiol, 2022, 23(8): 828-834.
28.	Lai PMR, Snyder KV, Levy EI. First reported series of intracranial and carotid aneurysm embolization performed at an ambulatory neurosurgery center: preliminary experience. J Neurointerv Surg, 2025, 18: jnis-2025-023228.
29.	Entezami P, Rock AK, Topp GP, et al. Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques. Interv Neuroradiol, 2024, 30(2): 163-169.
30.	Barkyoumb D, Balasubramanian K, Ibrahim S, et al. Feasibility of outpatient middle meningeal artery embolization for chronic subdural hematoma. Surg Neurol Int, 2025, 16: 277.
31.	Entezami P, Field NC, Dalfino JC. Outpatient management of chronic expanding subdural hematomas with endovascular embolization to minimize inpatient admissions during the COVID-19 viral pandemic. Interv Neuroradiol, 2021, 27(5): 716-721.
32.	中国研究型医院学会介入神经病学专委会经桡动脉介入协作组. 经桡动脉或远端桡动脉入路行脑血管介入操作中国专家共识. 中国脑血管病杂志, 2023, 20(1): 63-72, 封 3.
33.	Kim H, Lee HJ, Choi SW, et al. Comprehensive analysis of neurologic complications following transradial cerebral angiography. AJNR Am J Neuroradiol, 2025, 46(6): 1166-1172.
34.	Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol, 2015, 18(2): 58-65.
35.	Kaufmann TJ, Huston J 3rd, Mandrekar JN, et al. Complications of diagnostic cerebral angiography: evaluation of 19, 826 consecutive patients. Radiology, 2007, 243(3): 812-819.
36.	Tafelmeier S, Kesseler E, Iancu AM, et al. Spectrum of complications and complication rates after diagnostic catheter angiography in neuroradiology. Clin Neuroradiol, 2023, 33(3): 763-768.
37.	Thiex R, Norbash AM, Frerichs KU. The safety of dedicated-team catheter-based diagnostic cerebral angiography in the era of advanced noninvasive imaging. AJNR Am J Neuroradiol, 2010, 31(2): 230-234.
38.	Shen J, Karki M, Jiang T, et al. Complications associated with diagnostic cerebral angiography: a retrospective analysis of 644 consecutive cerebral angiographic cases. Neurol India, 2018, 66(4): 1154-1158.
39.	中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组. 脑血管造影术操作规范中国专家共识. 中华神经科杂志, 2018, 51(1): 7-13.
40.	《冠状动脉造影日间手术专家共识》撰写委员会, 曾春雨, 张瑞岩, 等. 冠状动脉造影日间手术专家共识. 中华高血压杂志, 2023, 31(10): 902-907.
41.	Solomon R. Preventing contrast-induced nephropathy: problems, challenges and future directions. BMC Med, 2009, 7: 24.
42.	Lachat ML, Pecoraro F, Mayer D, et al. Outpatient endovascular aortic aneurysm repair: experience in 100 consecutive patients. Ann Surg, 2013, 258(5): 754-759.
43.	Jaroenngarmsamer T, Bhatia KD, Kortman H, et al. Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis. J Neurointerv Surg, 2020, 12(1): 87-93.
44.	中华医学会神经外科学分会, 中华医学会麻醉学分会, 中国医疗保健国际交流促进会加速康复外科学分会. 未破裂颅内动脉瘤患者加速康复外科临床实践指南. 中华医学杂志, 2022, 102(41): 3257-3266.
45.	Amin AP, Pinto D, House JA, et al. Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes. JAMA Cardiol, 2018, 3(11): 1041-1049.
46.	Findlay MC, Baker CM, Childs S, et al. Analysis of treatment cost differences in patients undergoing femoral versus radial access in outpatient diagnostic cerebral arteriograms. Interv Neuroradiol, 2023, 10: 15910199231207408.
47.	Catapano JS, Ducruet AF, Koester SW, et al. Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures. J Neurointerv Surg, 2021, 13(8): 752-754.

1. Dawkins AA, Evans AL, Wattam J, et al. Complications of cerebral angiography: a prospective analysis of 2, 924 consecutive procedures. Neuroradiology, 2007, 49(9): 753-759.
2. Scullen TA, Lian MX, Jaikumar V, et al. First reported series of cerebral angiography performed at an outpatient center: safety and satisfaction results. Neurosurgery, 2025, 96(3): 539-544.
3. 于丽华. 中国日间手术发展的历程与展望. 中国医院管理, 2016, 36(6): 16-18.
4. Preece R, Stenson K, Shaw S, et al. Recent developments and current controversies in short-stay endovascular aneurysm repair. J Cardiovasc Surg (Torino), 2019, 60(4): 460-467.
5. 国家老年疾病临床医学研究中心(湘雅医院), 国家科技部内镜微创技术装备与标准国际联合研究中心. 综合医院日间手术室运行和管理中国专家共识(2022 版). 中华消化外科杂志, 2022, 21(9): 1173-1179.
6. Taxiarchi P, Kontopantelis E, Martin GP, et al. Same-day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. JACC Cardiovasc Interv, 2019, 12(15): 1479-1494.
7. Lai PMR, DeGaetano AC, Levy EI. Cerebral angiography in outpatient endovascular centers: roadmap and lessons learned from interventional radiology, cardiology, and vascular surgery. J Neurointerv Surg, 2025, 17(8): 907-908.
8. Agarwal S, Thakkar B, Skelding KA, et al. Trends and outcomes after same-day discharge after percutaneous coronary interventions. Circ Cardiovasc Qual Outcomes, 2017, 10(8): e003936.
9. Doby T. Cerebral angiography and Egas Moniz. AJR Am J Roentgenol, 1992, 159(2): 364.
10. 段传志, 李铁林. 神经介入放射学的发展现状及未来展望. 中华神经医学杂志, 2025, 24(1): 2-7.
11. 郭德华, 孔令华, 白卫星, 等. 脑血管介入手术机器人的研究进展. 中华放射学杂志, 2021, 55(6): 682-686.
12. Fifi JT, Meyers PM, Lavine SD, et al. Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol, 2009, 20(4): 442-447.
13. Qureshi AI, Naseem N, Saleem MA, et al. Migraine and non-migraine headaches following diagnostic catheter-based cerebral angiography. Headache, 2018, 58(8): 1219-1224.
14. Cho SM, Deshpande A, Pasupuleti V, et al. Radiographic and clinical brain infarcts in cardiac and diagnostic procedures: a systematic review and meta-analysis. Stroke, 2017, 48(10): 2753-2759.
15. Lapow JM, Pammal RS, Brozynski M, et al. Complication rates following cerebral and coronary angiography: nationwide analysis 2008-2014. Cardiol Rev, 2024, 32(6): 507-512.
16. Rai AT, Domico J. Routine pre-procedure laboratory testing for patients undergoing outpatient cerebral angiography is not indicated. J Neurointerv Surg, 2013, 5(2): 172-176.
17. Jeong YG, Kim EH, Hwang SM, et al. Outpatient (same-day care) neuroangiography and neurointervention. Neurointervention, 2012, 7(1): 17-22.
18. Liu H, Park D, Hwang SM, et al. Outpatient day-care neuroangiography and neurointervention of unruptured intracranial aneurysms. Neurointervention, 2016, 11(1): 37-41.
19. Behrens L, Adam A, Rubeck A, et al. Safety aspects and procedural characteristics of ambulatory diagnostic cerebral catheter angiography. Clin Neuroradiol, 2024, 34(1): 155-162.
20. Razavi SM, Masangkay E, Chelikam N, et al. Safety of cerebral angiography in private outpatient clinical setting. Ann Neurol, 2020, 88: S169-S169.
21. Heyde GS, Koch KT, de Winter RJ, et al. Randomized trial comparing same-day discharge with overnight hospital stay after percutaneous coronary intervention: results of the Elective PCI in Outpatient Study (EPOS). Circulation, 2007, 115(17): 2299-2306.
22. Brayton KM, Patel VG, Stave C, et al. Same-day discharge after percutaneous coronary intervention: a meta-analysis. J Am Coll Cardiol, 2013, 62(4): 275-285.
23. Rao SV, Kaltenbach LA, Weintraub WS, et al. Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients. JAMA, 2011, 306(13): 1461-1467.
24. Hyasat K, Femia G, Alzuhairi K, et al. Safety, feasibility and economic analysis of same day discharge following elective percutaneous coronary intervention. Clin Med Insights Cardiol, 2022, 16: 11795468221116852.
25. Brown CS, Smith ME, Kim GY, et al. Exploring the rapid expansion of office-based laboratories and peripheral vascular interventions across the United States. J Vasc Surg, 2021, 74(3): 997-1005.e1.
26. Goland J, Doroszuk G, Ypa P, et al. Outpatient treatment of cerebral aneurysms: a case series. Surg Neurol Int, 2020, 11: 400.
27. Suh DC, Choi YH, Park SI, et al. Outpatient day-care management of unruptured intracranial aneurysm: a retrospective cohort study. Korean J Radiol, 2022, 23(8): 828-834.
28. Lai PMR, Snyder KV, Levy EI. First reported series of intracranial and carotid aneurysm embolization performed at an ambulatory neurosurgery center: preliminary experience. J Neurointerv Surg, 2025, 18: jnis-2025-023228.
29. Entezami P, Rock AK, Topp GP, et al. Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques. Interv Neuroradiol, 2024, 30(2): 163-169.
30. Barkyoumb D, Balasubramanian K, Ibrahim S, et al. Feasibility of outpatient middle meningeal artery embolization for chronic subdural hematoma. Surg Neurol Int, 2025, 16: 277.
31. Entezami P, Field NC, Dalfino JC. Outpatient management of chronic expanding subdural hematomas with endovascular embolization to minimize inpatient admissions during the COVID-19 viral pandemic. Interv Neuroradiol, 2021, 27(5): 716-721.
32. 中国研究型医院学会介入神经病学专委会经桡动脉介入协作组. 经桡动脉或远端桡动脉入路行脑血管介入操作中国专家共识. 中国脑血管病杂志, 2023, 20(1): 63-72, 封 3.
33. Kim H, Lee HJ, Choi SW, et al. Comprehensive analysis of neurologic complications following transradial cerebral angiography. AJNR Am J Neuroradiol, 2025, 46(6): 1166-1172.
34. Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol, 2015, 18(2): 58-65.
35. Kaufmann TJ, Huston J 3rd, Mandrekar JN, et al. Complications of diagnostic cerebral angiography: evaluation of 19, 826 consecutive patients. Radiology, 2007, 243(3): 812-819.
36. Tafelmeier S, Kesseler E, Iancu AM, et al. Spectrum of complications and complication rates after diagnostic catheter angiography in neuroradiology. Clin Neuroradiol, 2023, 33(3): 763-768.
37. Thiex R, Norbash AM, Frerichs KU. The safety of dedicated-team catheter-based diagnostic cerebral angiography in the era of advanced noninvasive imaging. AJNR Am J Neuroradiol, 2010, 31(2): 230-234.
38. Shen J, Karki M, Jiang T, et al. Complications associated with diagnostic cerebral angiography: a retrospective analysis of 644 consecutive cerebral angiographic cases. Neurol India, 2018, 66(4): 1154-1158.
39. 中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组. 脑血管造影术操作规范中国专家共识. 中华神经科杂志, 2018, 51(1): 7-13.
40. 《冠状动脉造影日间手术专家共识》撰写委员会, 曾春雨, 张瑞岩, 等. 冠状动脉造影日间手术专家共识. 中华高血压杂志, 2023, 31(10): 902-907.
41. Solomon R. Preventing contrast-induced nephropathy: problems, challenges and future directions. BMC Med, 2009, 7: 24.
42. Lachat ML, Pecoraro F, Mayer D, et al. Outpatient endovascular aortic aneurysm repair: experience in 100 consecutive patients. Ann Surg, 2013, 258(5): 754-759.
43. Jaroenngarmsamer T, Bhatia KD, Kortman H, et al. Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis. J Neurointerv Surg, 2020, 12(1): 87-93.
44. 中华医学会神经外科学分会, 中华医学会麻醉学分会, 中国医疗保健国际交流促进会加速康复外科学分会. 未破裂颅内动脉瘤患者加速康复外科临床实践指南. 中华医学杂志, 2022, 102(41): 3257-3266.
45. Amin AP, Pinto D, House JA, et al. Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes. JAMA Cardiol, 2018, 3(11): 1041-1049.
46. Findlay MC, Baker CM, Childs S, et al. Analysis of treatment cost differences in patients undergoing femoral versus radial access in outpatient diagnostic cerebral arteriograms. Interv Neuroradiol, 2023, 10: 15910199231207408.
47. Catapano JS, Ducruet AF, Koester SW, et al. Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures. J Neurointerv Surg, 2021, 13(8): 752-754.

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