Recurrent Aneurysmal Subarachnoid Haemorrhage: Incidence, timing and effects. A re-appraisal in a surgical series

O'Neill, Padraic; West, Christopher Robert; Chadwick, David; Conway, Michael; Foy, P. M.; Maloney, Peter; Pickard, John D.; Spillane, J. A.; Shaw, M. D. M.

doi:10.3109/02688698808999657

Cited by 13 publications

(6 citation statements)

References 17 publications

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“…5,17,27,43,46,50,53,58 Nevertheless, although rebleeding occurs in 15 to 30% of patients during the first 2 weeks of conservative treatment, the influence of early intervention on overall outcome is still a matter of debate. 37,52,58 Our data clearly show that close collaboration with local referring hospitals permits effective application of a protocol for immediate diagnosis and transfer of patients with SAH to neurosurgical centers on a large scale.…”

Section: Ultraearly Rerupturementioning

confidence: 98%

Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study

Hillman¹,

Friðriksson²,

Nilsson³

et al. 2002

Journal of Neurosurgery

327

221

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More than 90% of patients reached the neurosurgical center within 12 hours of their first hospital admission after SAH; 70% of all aneurysms were clipped or coils were inserted within 24 hours of the first hospital admission. Given the protocol, only one rebleed occurred later than 24 hours after the first hospital admission. Despite this strong emphasis on early intervention, however, a cluster of 27 very early rebleeds still occurred in the control group within hours of randomization into the study, and 13 of these patients died. In the tranexamic acid group, six patients rebled and two died. A reduction in the rebleeding rate from 10.8 to 2.4% and an 80% reduction in the mortality rate from early rebleeding with tranexamic acid treatment can therefore be inferred. Favorable outcome according to the GOS increased from 70.5 to 74.8%. According to TCD measurements and clinical findings, there were no indications of increased risk of either ischemic clinical manifestations or vasospasm that could be linked to tranexamic acid treatment. Neurosurgical guidelines for aneurysm rupture should extend also into the preneurosurgical phase to guarantee protection from ultraearly rebleeds. Currently available antifibrinolytic drugs can provide such protection, and at low cost. The number of potentially saved lives exceeds those lost to vasospasm.

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Section: Ultraearly Rerupturementioning

confidence: 98%

Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study

Hillman¹,

Friðriksson²,

Nilsson³

et al. 2002

Journal of Neurosurgery

327

221

View full text Add to dashboard Cite

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“…7,33 Our rebleed, rebleed and death, and clinical vasospasm leading to permanent deficit or death rates were 22, 11 and 15%, respectively, which are comparable to rates of larger series. 2,3,6,7,10,12,13,23,31 There are studies, however, wherein the rebleed rate is either significantly lower (10 -14%) due to ultra-early surgical/embolization management 21,34 or is under-reported due to patient selection criteria. 31 The same applies to clinical vasospasm and its contribution to morbidity and mortality figures.…”

Section: Discussionmentioning

confidence: 93%

“…2,3,6,7,10,12,13,23,31 There are studies, however, wherein the rebleed rate is either significantly lower (10 -14%) due to ultra-early surgical/embolization management 21,34 or is under-reported due to patient selection criteria. 31 The same applies to clinical vasospasm and its contribution to morbidity and mortality figures. Some studies 10,12,23,34 report clinical vasospasm rates of under 10%, which again is due to selection criteria and different surgical timing strategies.…”

Section: Discussionmentioning

confidence: 93%

Spontaneous subarachnoid haemorrhage in the era of transition from surgery to embolization. A study of the overall outcome

Stranjalis

Korfias

Vemmos

et al. 2005

British Journal of Neurosurgery

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The aim of the investigation was to evaluate the outcome of spontaneous subarachnoid haemorrhage, in the era of new techniques, patient centralization and subspecialization, by taking into account the local conditions in Greece. A prospective observational study was conducted during a 4-year period. All patients with a first-ever spontaneous subarachnoid haemorrhage were enrolled. Clinical, management and outcome data were recorded. Two-hundred-and-eighteen consecutive patients with an 81% good, medium clinical grade (Hunt & Hess I-III) were identified. Rebleed and rebleed leading to death rates were 22 and 11%, respectively. Permanent deficit or death from vasospasm was 15%. Twenty-eight per cent of the study population died early, were unsuitable for further management (poor clinical status, advanced age) or declined angiography or treatment, and another 22% had a negative angiogram. The remaining 50% underwent intervention (neurosurgical/endovascular), for obliteration of an aneurysm. The overall favourable 6-month outcome was 59%, whereas the favourable outcome of the intervention group was 70%. Our results confirm the findings of previous series. The relatively worse results are due to delayed referral, and lack of availability of surgical or endovascular management in the early post-haemorrhage period (28% of the patients), particularly in potentially salvageable cases. On the basis of these observations, we recommend early intervention (surgery or embolization) and centralization/subspecialization, in order to improve the outcome.

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“…Among these high risk cases many need urgent treatment. Furthermore, also in good grade patients earliest possible dipping has significant advantages as documented in the literature 7,9,15,16,IS,19,20,24,26. In contrast, most patients presenting later than one week after bleeding (< 5% of our cases) had no blood visible on computer tomography and obviously four vessel studies were required. It may seem unnecessary to investigate this special group of cases on a Sunday afternoon.…”

Section: Discussionmentioning

confidence: 93%

Selective angiography for early aneurysm detection in acute subarachnoid haemorrhage

Hillman

1993

Acta neurochir

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In a consecutive series of 312 surgical aneurysm cases more than 90% of the patients reached neurosurgical expertise within 48 hours from bleeding. Computed tomography permitted prediction of the assumed rupture site based on blood clot location in the majority (86%) of cases. This target vascular territory was usually investigated by selective angiography and in 9 out of 10 patients an aneurysm, ultimately shown to be the correct source of bleeding, was demonstrated. In 14% of the cases the source of bleeding could not be established thus calling for complete four vessel studies. It is concluded that limited angiographic studies are compatible with preserving a high surgical standard in cases unequivocally exhibiting a localizing clot pattern on the CT scan. Though suboptimal in a general sense, incomplete vascular studies, if four vessel angiography is not obtainable without delay or risk, should not delay earliest possible clipping of ruptured aneurysms to avoid the devastating effects of recurrent bleeds.

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Recurrent Aneurysmal Subarachnoid Haemorrhage: Incidence, timing and effects. A re-appraisal in a surgical series

Cited by 13 publications

References 17 publications

Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study

Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study

Spontaneous subarachnoid haemorrhage in the era of transition from surgery to embolization. A study of the overall outcome

Selective angiography for early aneurysm detection in acute subarachnoid haemorrhage

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