Effects of Hyper-Early (<12 Hours) Endovascular Treatment of Ruptured Intracranial Aneurysms on Clinical Outcome

Abstract

<jats:p> Despite the encouraging results obtained with the endovascular treatment of ruptured intracranial aneurysms, few data are available on the effects of the timing of this approach on clinical outcome. The aim of our study was to evaluate the effects of the hyper-early timing of treatment and of pre-treatment and treatment-related variables on the clinical outcome of patients with ruptured intracranial aneurysms. </jats:p><jats:p> Five hundred and ten patients (167 M, 343 F; mean age 56.45 years) with 557 ruptured intracranial aneurysms were treated at our institution from 2000 to 2011 immediately after their admission. The total population was divided into three groups: patients treated within 12 hours (hyper-early, group A), between 12–48 hours (early, group B) and after 48 hours (delayed, group C). A statistical analysis was carried out for global population and subgroups. </jats:p><jats:p> Two hundred and thirty-four patients (46%) were included in group A, 172 (34%) in group B and 104 (20%) in group C. Pre-treatment variables (Hunt&amp;Hess, Fisher grades, older age) and procedure-related variable (ischaemic/haemorrhagic complications) showed a significant correlation with worse clinical outcomes. The hyper-early treatment showed no correlation with good clinical outcomes. The incidence of intraprocedural complications was not significantly different between the three groups; 1.2% of pre-treatment rebleedings were observed. </jats:p><jats:p> The hyper-early endovascular treatment of ruptured intracranial aneurysm does not seem to be statistically correlated with good clinical outcomes although it may reduce the incidence of pre-treatment spontaneous rebleedings without being associated with a higher risk of intraprocedural complications. However, since no significant differences in terms of clinical outcome and pre-treatment rebleeding rate were observed, a hyper-early treatment is not be supported by our data. </jats:p>

Incidence of intra-procedural complications according to the timing of endovascular treatment in ruptured intracranial aneurysms

“…Philips et al ( 13 ) demonstrated that in their mixed surgical and endovascular series, the patients treated within 24 h after symptom onset had a better clinical outcome at 6 months. These data were confirmed by Consoli et al ( 14 ), who demonstrated that hyper-early endovascular treatment within 12 h after SAH is not associated with a lower morbidity or a better clinical outcome with respect to treatment after 12 h. Recently, Buscot et al ( 15 ) and Wu et al ( 16 ) showed that best clinical outcomes were achieved treating the patients at ~12.5 h.…”

Meta-analysis of timing of endovascular aneurysm treatment in subarachnoid haemorrhage: inconsistent results of early treatment within 1 day

“…There was variability in categorisation of treatment timing among studies (see online supplementary table 3 ) . Only one included study evaluated treatment timing at a time-point earlier than 1 day (ie, 0.5 days) 13. Since it was not possible to combine these data with any other study addressing the same timing categorisation, this time-point was not considered as a subgroup for data synthesis and analysis.…”

Complications et suivi des hémorragies méningées

“…jusqu'à 9 à 17 % dans les premières heures [3,6]. Il est souvent associé à un pronostic plus sombre, avec une augmentation du stade de Fisher [7] thérapeutique dans les 12 à 24 premières heures afin de limiter ce risque majeur de resaignement [8]. L'étude ISAT en 2002 a montré l'efficacité du traitement par coiling versus traitement chirurgical dans la prise en charge des ané-vrismes rompus avec un risque de dépendance et de décès respectifs mesurés à 23,7 % versus 30,6 % (p = 0,0019) [9].…”