Ultra-early endovascular treatment improves prognosis in High grade aneurysmal subarachnoid hemorrhage: A single-center retrospective study

Abstract

BackgroundThe long-term survival prognosis of patients with high-grade (Hunt-Hess grade IV–V or World Federation of Neurosurgical Societies grade IV–V) aneurysmal subarachnoid hemorrhage (aSAH) is generally poor, and the association between endovascular treatment timing and the prognosis of high-grade aSAH has not been explored in depth. This retrospective cohort study aimed to determine whether endovascular treatment within 24 h of high-grade aSAH is associated with a better prognosis.MethodsWe retrospectively analyzed the clinical data of patients with high-grade aSAH who were admitted to our institution between January 2018 and January 2021. The Modified Rankin Scale score was used to assess the 6-month prognosis of patients. Univariate and multivariate logistic regression analyses were used to identify the factors associated with prognosis. The area under the receiver operating characteristic (ROC) curve was used to assess the model's discriminatory ability.ResultsEighty-six patients were included in the study. In the multivariate analysis, the timing of endovascular treatment (odds ratio = 7.003 [1.800–27.242], P = 0.005) was an independent risk factor for prognosis. The ROC curve showed that the predictive power of the timing of endovascular treatment was 0.744, the best cut-off value was 12.5 h, and the corresponding sensitivity and specificity were 71.4 and 70.5%, respectively. Hydrocephalus (P = 0.005) and pulmonary infection (P = 0.029) were also associated with prognosis. In addition, cerebrospinal fluid drainage immediately after endovascular treatment had a significant effect on reducing hydrocephalus formation.ConclusionsEndovascular therapy within 24 h is feasible and improves the prognosis of patients with high-grade aSAH.

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.…”

“…In 2013, the European Stroke Organization underlined that the treatment should be aimed at least within 72 h after onset of first symptoms (4). Only few studies have focused on the best timing of treatment after SAH and most of them included only surgical clipping or both surgical and endovascular treatments (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The definition of hyper-early, early, and delayed treatment varies widely in the different studies and their results are contradictory.…”

Explainable machine learning in outcome prediction of high-grade aneurysmal subarachnoid hemorrhage

“…In recent years, numerous prediction models have been extensively developed to forecast the clinical outcomes in high-grade aSAH patients [ 4 ]. However, the majority of these models rely on conventional algorithms with limited clinical features.…”

An Excellent Functional Recovery Following Grade IV Subarachnoid Hemorrhage From a Cerebral Aneurysm Rebleed With Ultra-Early Surgical Intervention: A Case Report

“…Historically, surgical intervention was done within seven days of the event, but researchers showed that patients experienced better outcomes if it was done within the first 72 hours [7,8]. Furthermore, evidence shows improved outcomes in patients who underwent ultra-early surgical intervention within 24 hours of ictus [9][10][11]. This case report concerns a 49-year-old male who underwent ultra-early surgical intervention after an aSAH rebleed and had excellent functional recovery during his six-month post-operative visit.…”