Title:Early Timing of Endovascular Treatment for Aneurysmal Subarachnoid Hemorrhage Achieves Improved Outcomes
Volume: 11
Issue: 1
Author(s): Zenghui Qian, Tangming Peng, Aihua Liu, Youxiang Li, Chuhan Jiang, Hongchao Yang, Jing Wu, Huibin Kang and Zhongxue Wu
Affiliation:
Keywords:
Clinical outcomes, Endovascular treatment, Follow-up, Intracranial aneurysmal, Subarachnoid hemorrhage, Timing.
Abstract: Timing of treatment of aneurysmal subarachnoid hemorrhage has been controversial. This retrospective study
was designed to access the safety and efficacy among cohorts of different timing of endovascular treatment patients with
aneurysmal subarachnoid hemorrhage. A database of patients with aneurysmal subarachnoid hemorrhage was analyzed
who were confirmed by CT, and underwent endovascular treatment between January 2005 and January 2012,. The
patients were grouped into four cohorts according to the timing of treatment: ultra-early cohort (within 24 hours of onset
which was confirmed by CT), early cohort (between 24 and 72 hours of onset which was confirmed by CT), intermediate
cohort (between 4 and 10 days of onset which was confirmed by CT) and delayed cohort (after 11 days of onset which
was confirmed by CT). Patient demographics, aneurysms features and clinical outcomes were analyzed to evaluate safety
and efficacy for timing of endovascular treatment among four cohorts. In our series of 664 patients, 269 patients were
grouped into ultra-early cohort, 62 patients in early cohort, 218 patients in intermediate cohort, and 115 patients in
delayed cohort. The patient demographics, aneurysm characteristics and neurological conditions on admission among
groups showed no statistical significance. As a result of the 9-month follow-up with 513 patients, good outcome
(mRS<2) was achieved in 78% patients in “ultra-early” cohort compared with that of 57% in the “intermediate”
group(p=0.000), whereas other comparisons showed no statistical significance(p>0.05) among the four groups. Dividing
the patients with dichotomized mRS into “good outcome” group and “poor outcome” group (mRS>2) at the 9-month
follow-up, the results showed lower Hunt-Hess scores (p=0.000) and smaller size of aneurysms (p=.001) which were
correlated with the good outcome. Hypertension (p=0.776), age (p=0.327), sex (p=0.551) and location (p=0.901) showed
no statistical significance between groups. Endovascular treatment of aneurysmal subarachnoid hemorrhage which was
confirmed by CT within 72 hours achieved better outcomes than that confirmed after 72 hours, especially in those patients
treated within 24 hours of onset in comparison with patients treated between 4 and 10 days.
