Comparison of the timing of intervention and treatment modality of poor-grade aneurysmal subarachnoid hemorrhage

Tykocki, Tomasz; Czyż, Marcin; Machaj, Małgorzata; Szydlarska, Dorota; Kostkiewicz, Bogusław

doi:10.1080/02688697.2017.1319906

Cited by 19 publications

(16 citation statements)

References 16 publications

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“…First, the proportion of patients in whom poor outcome from rebleeding is prevented is small. Second, while some recent studies suggest ultra-early aneurysm repair is associated with better outcomes at 3 months, 5,10 one large observational study failed to show this correlation, concluding that aneurysm treatment within 24 h was not associated with better outcomes compared to treatment 24-72 h after ictus and might even be detrimental. 15 Moreover, emergency occlusion, if applied to all patients, carries risks such as an increase in periprocedural complications or the induction of delayed cerebral ischaemia (DCI).…”

Section: Discussionmentioning

confidence: 98%

“…The incidence and timing of in-hospital rebleeding in our study is in line with incidences observed in previous studies, which ranged between 5.6% and 12%. 7,[10][11][12][13] Two previous studies investigated the proportion of patients with rebleeding resulting in death or disability, that could have been prevented with an emergency treatment protocol. A study from South Korea demonstrated that 2/100 (2.0%) episodes of rebleeding could have been prevented with a protocol for emergency aneurysm treatment (3.5 h mean time from admission to intervention).…”

Section: Discussionmentioning

confidence: 99%

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Preventable poor outcome from rebleeding by emergency aneurysm occlusion in patients with aneurysmal subarachnoid haemorrhage

Tack

Vergouwen

Schaaf

et al. 2019

European Stroke Journal

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Introduction: The risk of rebleeding is highest during the initial hours after aneurysmal subarachnoid haemorrhage (aSAH), but the aneurysm is not occluded in all patients immediately after admission. Our aim was to determine the proportion of aSAH patients with poor outcome from early in-hospital rebleeding that can be prevented by three emergency aneurysm occlusion regimes. Patients and methods: From our prospectively collected database, we retrieved from all aSAH patients admitted between July 2007 and July 2017 data on clinical condition on admission, time of rebleeding, and outcome at 3 months. Results: Of 1391 consecutive aSAH patients, 923 were in good clinical condition and had an aneurysm on initial imaging that was amenable for treatment. Poor outcome from rebleeding could have been avoided by treatment <4 h during day time shifts in 4 (0.4% [95% CI: 0.2-1.1]) patients (number needed to treat [NNT]: 250), by treatment and <1 h during daytime shift in 9 (1.0% [95% CI: 0.5-1.8]; NNT: 111), and treatment <1 h at 24/7 basis in 16 (1.7% [95% CI: 1.1-2.8%]; NNT: 59). Discussion: Emergency aneurysm occlusion can reduce poor outcome due to rebleeding, but only in small proportions of patients. Whether such strategies lead to improved outcome for all patients and are cost-effective is highly uncertain. Conclusion: We do not recommend instalment of a treatment regimen where occlusion of ruptured aneurysm is performed within 1 h on a 24/7 basis.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Preventable poor outcome from rebleeding by emergency aneurysm occlusion in patients with aneurysmal subarachnoid haemorrhage

Tack

Vergouwen

Schaaf

et al. 2019

European Stroke Journal

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“…It is noticeable that not many studies concerning CIA focus on SAH patients [ 11 ]. Becuase this group is considered to be more at risk of developing complications and increased mortality, the presence of additional risk factors, such as CIA, could be particularly unfavourable [ 15 , 19 , 20 ]. Therefore, corresponding analysis for SAH patients only was performed in our study.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of complex intracranial aneurysms

et al. 2018

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PurposeComplex intracranial aneurysms (CIA) are heterogenous group of intracranial vascular malformations. Due to its giant size, difficult location, broad neck, branches arising from the aneurysm, wall structure, calcification, presence of intraluminal thrombus or previous treatments it requires more careful approach. The aim of this study was to evaluate endovascular treatment results of CIA in our Department.Material and methodsIn order to differentiate CIA from all the aneurysms, treated endovascularly in years 2008-2014, authors proposed their own qualification criteria. Additionally, subgroup of patients with CIA with simultaneous subarachnoid haemorrhage (SAH) was divided. Clinical outcomes of patients were assessed with Glasgow Outcome Scale (GOS), while radiological outcomes were assessed with Montreal Scale. Aneurysm localization, incidence of aborted procedures, intraoperative complications were also evaluated.ResultsInternal carotid artery was the most common localization in both CIA and non-complex (nCIA) groups. Incidence of aborted procedures was significantly higher in CIA group than in nCIA (25% vs. 7%; p < 0.01). CIA group had worse Montreal scores then nCIA group (1.90 vs. 1.49; p < 0.01). Clinical outcome in GOS scale in patients with SAH and CIA was significantly worse than in SAH and nCIA (2.86 vs. 4.06; p = 0.04).ConclusionsTo conclude, proposed criteria of CIA should be taken into consideration during diagnosis and qualification to invasive treatment. Classifying aneurysm as CIA is related to greater possibility of aborting endovascular procedure due to technical difficulties.

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“…В этой работе статистически значимых различий в исходах заболевания по mRS при выполнении клипирования и эндоваскулярного лечения выявлено не было. Таким образом, полученные в этой работе данные свидетельствуют об улучшении функционального исхода заболевания при ультрараннем оперативном лечении пациентов с САК [29].…”

Section: ультраранняя рентгенэндоваскулярная эмболизацияunclassified

Evaluation of the Efficiency of Ultra-Early Endovascular Embolization of Cerebral Aneurisms in Subarachnoid Hemorrage

Шалыгин

Gorbunov

Дергилев

et al. 2021

Vestn. rentgenol. radiol.

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РезюмеВ обзоре обсуждается эффективность рентгенэндоваскулярной эмболизации интракраниальных аневризм при субарахноидальном кровоизлиянии (САК) в первые 24 ч после разрыва. Необходимость данного исследования продиктована медико-социальной значимостью заболевания, в частности высокой степенью летальности и инвалидизации при САК аневризматического генеза, в том числе у молодых пациентов. Выбор сроков рентгенэндоваскулярной эмболизации при САК остается предметом дискуссии профессионального сообщества с момента внедрения метода в клиническую практику. Выполнение эмболизации в 1-е сутки с момента дебюта заболевания, так называемая ultra-early embolization (ультраранняя эмболизация), потенциально положительно влияет на исходы САК, снижая количество летальных случаев и увеличивая число благоприятных исходов. Основным преимуществом данной тактики является предотвращение повторного разрыва аневризмы, вероятность которого наиболее высока в 1-е сутки заболевания, а также возможность начала интенсивной терапии САК в самые ранние сроки. Ключевые слова: субарахноидальное кровоизлияние; церебральная аневризма; ультраранняя эндоваскулярная эмболизация; обзор. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

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Comparison of the timing of intervention and treatment modality of poor-grade aneurysmal subarachnoid hemorrhage

Abstract: Early treatment, within 24 h, of poor-grade aSAH confirmed better clinical outcome compared to later aneurysm securement. There was no significant difference between clipping and endovascular treatment.

Cited by 19 publications

References 16 publications

Preventable poor outcome from rebleeding by emergency aneurysm occlusion in patients with aneurysmal subarachnoid haemorrhage

Preventable poor outcome from rebleeding by emergency aneurysm occlusion in patients with aneurysmal subarachnoid haemorrhage

Endovascular treatment of complex intracranial aneurysms

Evaluation of the Efficiency of Ultra-Early Endovascular Embolization of Cerebral Aneurisms in Subarachnoid Hemorrage

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