Clinical Impact and Predictors of Aneurysmal Rebleeding in Poor-Grade Subarachnoid Hemorrhage: Results From the National POGASH Registry

Panni, Pietro; Riccio, Lucia; Cao, Roberta; Pedicelli, Alessandro; Marchese, Enrico; Caricato, Anselmo; Feletti, Alberto; Testa, Mattia; Zanatta, Paolo; Gitti, Nicola; Piva, Simone; Mardighian, Dikran; Semeraro, Vittorio; Nardin, Giordano; Lozupone, Emilio; Paiano, Giafranco; Picetti, Edoardo; Montanaro, Vito; Petranca, Massimo; Bortolotti, Carlo; Scibilia, Antonino; Cirillo, Luigi; Lanterna, Luigi Andrea; Ambrosi, Alessandro; Mortini, Pietro; Beretta, Luigi; Falini, Andrea

doi:10.1227/neu.0000000000002467

Cited by 6 publications

(1 citation statement)

References 43 publications

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“…They discovered that ruptured posterior circulation aneurysms were predictors of NPE and TLC ( 29 ) which may lead to an inauspicious outcome. Another reason may be related to the more frequent localization of dissecting aneurysms in the posterior circulation and their correlation with aneurysmal rebleeding that may lead to a fatal outcome ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience

Scibilia,

Rustici,

Linari

et al. 2024

Front. Neurol.

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BackgroundThe management of patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is burdened by an unfavorable prognosis even with aggressive treatment. The aim of the present study is to investigate the risk factors affecting 30-day mortality in poor-grade aSAH patients.MethodsWe performed a retrospective analysis of a prospectively collected database of poor-grade aSAH patients (World Federation of Neurosurgical Societies, WFNS, grades IV and V) treated at our institution from December 2010 to December 2020. For all variables, percentages of frequency distributions were analyzed. Contingency tables (Chi-squared test) were used to assess the association between categorical variables and outcomes in the univariable analysis. Multivariable analysis was performed by using the multiple logistic regression method to estimate the odds ratio (OR) for 30-day mortality.ResultsA total of 149 patients were included of which 32% had WFNS grade 4 and 68% had WFNS grade 5. The overall 1-month mortality rate was 21%. On univariable analysis, five variables were found to be associated with the likelihood of death, including intraventricular hemorrhage (IVH ≥ 50 mL, p = 0.005), the total amount of intraventricular and intraparenchymal hemorrhage (IVH + ICH ≥ 90 mL, p = 0.019), the IVH Ratio (IVH Ratio ≥ 40%, p = 0.003), posterior circulation aneurysms (p = 0.019), presence of spot sign on initial CT scan angiography (p = 0.015).Nonetheless, when the multivariable analysis was performed, only IVH Ratio (p = 0.005; OR 3.97), posterior circulation aneurysms (p = 0.008; OR 4.05) and spot sign (p = 0.022; OR 6.87) turned out to be independent predictors of 30-day mortality.ConclusionThe risk of mortality in poor-grade aSAH remains considerable despite maximal treatment. Notwithstanding the limitations of a retrospective study, our report highlights some neuroradiological features that in the emergency setting, combined with leading clinical and anamnestic parameters, may support the multidisciplinary team in the difficult decision-making process and communication with family members from the earliest stages of poor-grade aSAH. Further prospective studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience

Scibilia,

Rustici,

Linari

et al. 2024

Front. Neurol.

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Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm—illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months

Autio,

Paavola,

Tervonen

et al. 2024

Acta Neurochir

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Purpose In aneurysmal intracerebral hemorrhage (aICH), our review showed the lack of the patient’s individual (i) timeline panels and (ii) serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. Methods Our retrospective cohort consists of 54 consecutive aICH patients from a defined population who acutely underwent the clipping of a middle cerebral artery bifurcation saccular aneurysm (Mbif sIA) with the aICH evacuation at Kuopio University Hospital (KUH) from 2010 to 2019. We constructed the patient’s individual timeline panels since the emergency call and serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. The patients were indicated by numbers (1.–54.) in the pseudonymized panels, tables, results, and discussion. Results The aICH volumes on KUH admission (median 46 cm3) plotted against the time from the emergency call to the evacuation (median 8 hours) associated significantly with the rebleeds (n=25) and the deaths (n=12). The serial CT/MRI slice panels illustrated the aICHs, intraventricular hemorrhages (aIVHs), residuals after the aICH evacuations, perihematomal edema (PHE), delayed cerebral injury (DCI), and in the 42 survivors, the clinical outcome (mRS) and the brain tissue outcome. Conclusions Regarding aICH evacuations, serial brain CT/MRI panels present more information than words, figures, and graphs. Re-bleeds associated with larger aICH volumes and worse outcomes. Swift logistics until the sIA occlusion with aICH evacuation is required, also in duty hours and weekends. Intraoperative CT is needed to illustrate the degree of aICH evacuation. PHE may evoke uncontrollable intracranial pressure (ICP) in spite of the acute aICH volume reduction.

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Targeted Temperature Management for Poor Grade Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

Liu,

Li,

Han

et al. 2024

World Neurosurgery

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Clinical Impact and Predictors of Aneurysmal Rebleeding in Poor-Grade Subarachnoid Hemorrhage: Results From the National POGASH Registry

Cited by 6 publications

References 43 publications

Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience

Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience

Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm—illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months

Targeted Temperature Management for Poor Grade Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

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