Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage

Abstract

Objective:To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment.Methods:In this prospective observational study, mortality and poor outcome (modified Rankin Scale 3-6) were analyzed in 311 patients with aSAH at 3-month, 1-year, and 5-year follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed.Results:Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months, with an absolute difference of 15.8%, and at 1 year, with an absolute difference of 15.9%. In both groups, Number Needed to Treat was 6.3. Odds ratios (OR) were 0.36 [95%CI 0.18-0.74] for endovascular and 0.40 [95%CI 0.20-0.81] for neurosurgical treatment. Complications did not differ between the two procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR=0.67 [95%CI 0.54-0.84)].Conclusions:Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.

The Role of the Blood Neutrophil-to-Lymphocyte Ratio in Aneurysmal Subarachnoid Hemorrhage

“…The mortality rate of aSAH is quite high, and survivors are typically left with prolonged functional impairments, but accurate estimation of the prognosis of aSAH patients has been challenging ( 83 ). At present, the most important prognostic determinants for the aSAH outcome are the neurological grade on initial examination, radiographic results, and age ( 84 , 85 ).…”

Predictors of poor outcome from aneurysmal subarachnoid hemorrhage and an exploratory analysis into the causes of delayed neurosurgical clipping at a major public hospital in the Philippines

“…44,45 The rates of unfavorable outcomes were 43.3% and 22%, while mortality rates were 18.4% and 5.9% in studies by Roquer et al 44 and Macdonald et al 45 , respectively. Factors such as intraoperative rupture and vasospasm were similarly found to be independent predictors of poor outcomes in those studies, 44,45,46 despite the fact that their contemporary series of patients had been given the option of treatment by both open surgical and endovascular means. Our experience, however, remains to stand in stark contrast to that of ideal wellresourced settings.…”

Sevoflurane and Desflurane Exposures Following Aneurysmal Subarachnoid Hemorrhage Confer Multifaceted Protection against Delayed Cerebral Ischemia

“…Aneurysmal subarachnoid hemorrhage (SAH) affects approximately 500,000 people/year worldwide [1] and accounts for over 70% of all forms of subarachnoid hemorrhage [2]. Roughly 30% of these patients die and 50% of survivors experience substantial deficits [2,3].…”