Outcome after In-Hospital Rebleeding of Rupture of Intracranial Aneurysms

Kienzler, Jenny; Marbacher, Serge; Remonda, Luca; Soleman, Jehuda; Schlaeppi, Janine Ai; Leupold, Ulrich; Fandiño, Javier

doi:10.1055/s-0035-1570007

Cited by 20 publications

(4 citation statements)

References 37 publications

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“…Despite several reports on the dismal prognosis of inhospital rebleeding [8,19,20], we found 68.2% favorable outcome (mRS=0, 1 and 2) in our series. We believe that the lobectomy with a large Frazier suction tip (Fr 12) in this technique provides the ideal surgical corridor for access to the aneurysm and its main feeders without causing significant neurologic damages (Figure 1; A, B and C).…”

Section: Discussioncontrasting

confidence: 99%

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Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Rahmanian

Derakhshan

Alibai

2018

Iran. J. Neurosurg.

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In-hospital rebleeding and early aneurysm rupture are major causes of mortality and morbidity in aneurysmal subarachnoid hemorrhage. Rebleeding may occur at the referring hospital, during transfer or at the referral neurovascular center prior to surgical or endovascular treatment. However, there has been no report regarding the rate of in-hospital rebleeding and early aneurysm rupture at the referral centers. This study aims to clarify the incidence, significance, management, and outcome of individuals who suffer in-hospital aneurysmal rebleeding and early aneurysm rupture at the referral hospital due to anterior circulation cerebral aneurysm to the time when its neck is visualized for clipping. Methods and Materials/Patients: Among 617 patients with anterior circulation cerebral aneurysms, who underwent operation between September 2010 and September 2017 at Neurovascular Unit of Namazi Hospital (main referral neurovascular center in southern Iran), 22 suffered rebleeding since the time of neuroradiologic diagnosis of aneurysm to intraoperative visualization of aneurysm for neck dissection. A surgical technique for fast access and securing the aneurysm is described in this article, too. The patients' demographics were collected via hospital records in a retrospective fashion. Six-month functional outcome was obtained via OPD records as well as phone calls. Performing Independent t test, 1-way ANOVA, Kruskal-Wallis and Mann-Whitney tests in SPSS22, the effect of each study variable was evaluated during 6 months followup period. Results: Rebleeding occurred at different venues from CT angiography to frontal lobe retraction. Anterior communicating artery was the most common aneurysm to suffer in-hospital rebleeding and male gender was found as a risk factor. These patients have significantly higher bleeding amount and longer operative time (P<0.001), but still have a 68.2% chance of survival with good functional recovery. Earlier in-hospital rebleedings used to have worse outcomes (P=0.036 for GOS and 0.028 for mRS, respectively). Conclusion: Patients with in-hospital rebleeding and early aneurysm rupture at the referral hospitals will have a considerable chance for favorable outcome if they undergo aggressive surgical management emergently.

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Section: Discussioncontrasting

confidence: 99%

“…With the provided technique, we have achieved favorable outcomes in as much as 68% (15 of 22) of patients. functional outcome [8,19,20]. Data regarding the efficacy of antifibrinolytics in prevention of rebleeding are equivocal [21] and early surgery still remains the only hope they have for survival.…”

Section: Plain Language Summarymentioning

confidence: 99%

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Rahmanian

Derakhshan

Alibai

2018

Iran. J. Neurosurg.

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“…Intracranial aneurysms (IAs), a common cerebrovascular disease in the aging population, refer to the main cause of subarachnoid hemorrhage. Rebleeding is recognized as a catastrophic event with high mortality after aneurysmal subarachnoid hemorrhage (aSAH) (Rosenørn et al, 1987;Jaechan et al, 2015;Kienzler et al, 2016). Though timely surgical intervention can effectively protect aSAH patients from poor outcome (Ko et al, 2011;Cordonnier et al, 2018;Darkwah Oppong et al, 2018), for several reasons, a notable number of patients cannot receive treatment as soon as they are sent to a hospital.…”

Section: Introductionmentioning

confidence: 99%

Rebleeding of Ruptured Intracranial Aneurysm After Admission: A Multidimensional Nomogram Model to Risk Assessment

Yang

et al. 2021

Front. Aging Neurosci.

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ObjectiveRebleeding is recognized as the main cause of mortality after intracranial aneurysm rupture. Though timely intervention can prevent poor prognosis, there is no agreement on the surgical priority and choosing medical treatment for a short period after rupture. The aim of this study was to investigate the risk factors related to the rebleeding after admission and establish predicting models for better clinical decision-making.MethodsThe patients with ruptured intracranial aneurysms (RIAs) between January 2018 and September 2020 were reviewed. All patients fell to the primary and the validation cohort by January 2020. The hemodynamic parameters were determined through the computational fluid dynamics simulation. Cox regression analysis was conducted to identify the risk factors of rebleeding. Based on the independent risk factors, nomogram models were built, and their predicting accuracy was assessed by using the area under the curves (AUCs).ResultA total of 577 patients with RIAs were enrolled in this present study, 86 patients of them were identified as undergoing rebleeding after admission. Thirteen parameters were identified as significantly different between stable and rebleeding aneurysms in the primary cohort. Cox regression analysis demonstrated that six parameters, including hypertension [hazard ratio (HR), 2.54; P = 0.044], bifurcation site (HR, 1.95; P = 0.013), irregular shape (HR, 4.22; P = 0.002), aspect ratio (HR, 12.91; P < 0.001), normalized wall shear stress average (HR, 0.16; P = 0.002), and oscillatory stress index (HR, 1.14; P < 0.001) were independent risk factors related to the rebleeding after admission. Two nomograms were established, the nomogram including clinical, morphological, and hemodynamic features (CMH nomogram) had the highest predicting accuracy (AUC, 0.92), followed by the nomogram including clinical and morphological features (CM nomogram; AUC, 0.83), ELAPSS score (AUC, 0.61), and PHASES score (AUC, 0.54). The calibration curve for the probability of rebleeding showed good agreement between prediction by nomograms and actual observation. In the validation cohort, the discrimination of the CMH nomogram was superior to the other models (AUC, 0.93 vs. 0.86, 0.71 and 0.48).ConclusionWe presented two nomogram models, named CMH nomogram and CM nomogram, which could assist in identifying the RIAs with high risk of rebleeding.

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“…The median time from initial haemorrhage to early rebleeding has been reported to be 3.5-4 h (9,17). Time to treatment was dichotomized around 4 hours (referred to as short and long time to treatment, respectively).…”

Section: Civil Registration Systemmentioning

confidence: 99%

Neurosurgical Admission Later Than 4 h After the Emergency Call Does Not Result in Worse Long-Term Outcome in Subarachnoid Haemorrhage

et al. 2021

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Background: Few studies have investigated the importance of the time interval between contact to the emergency medical service and neurosurgical admission in patients with spontaneous subarachnoid haemorrhage. We hypothesised that longer time to treatment would be associated with an increased risk of death or early retirement.Methods: This was a retrospective observational study with 4 years follow-up. Those who reached a neurosurgical department in fewer than 4 h were compared with those who reached it in more than 4 h. Individual level data were merged from the Danish National Patient Register, medical records, the Copenhagen Emergency Medical Dispatch Centre, the Civil Registration System, and the Ministry of Employment and Statistics Denmark. Patients were ≥18 years and had a verified diagnosis of spontaneous subarachnoid haemorrhage. The primary outcome was death or early retirement after 4 years.Results: Two hundred sixty-two patients admitted within a three-and-a-half-year time period were identified. Data were available in 124 patients, and 61 of them were in their working age. Four-year all-cause mortality was 25.8%. No significant association was found between time to neurosurgical admission and risk of death or early retirement (OR = 0.35, 95% confidence interval [CI]: 0.10–1.23, p = 0.10).Conclusion: We did not find an association between the time from emergency telephone call to neurosurgical admission and the risk of death or early retirement.

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Outcome after In-Hospital Rebleeding of Rupture of Intracranial Aneurysms

Cited by 20 publications

References 37 publications

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center

Rebleeding of Ruptured Intracranial Aneurysm After Admission: A Multidimensional Nomogram Model to Risk Assessment

Neurosurgical Admission Later Than 4 h After the Emergency Call Does Not Result in Worse Long-Term Outcome in Subarachnoid Haemorrhage

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