Ultra-Early Treatment for Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Han, Yangyun; Feng, Yue; Long, Xiaodong; Li, Aiguo; Xu, Hong; Zou, Li; Yang, Yifeng; You, Chao

doi:10.1016/j.wneu.2018.03.219

Cited by 35 publications

(36 citation statements)

References 29 publications

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“…Ideally, aneurysm obliteration should be performed as early as possible to prevent re-bleeding 8,9 . However, the benefits of early definitive treatment remain controversial for patients with aSAH 50 , especially for those with poorgrade aSAH. One study showed early definitive treatment to be associated with less re-bleeding and a higher proportion of favorable outcomes 18 , while another did not 51 .…”

Section: Discussionmentioning

confidence: 99%

Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage

et al. 2019

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Background: Little is known regarding functional outcome following poor-grade (World Federation of Neurosurgical Societies grades IV and V) aneurysmal subarachnoid hemorrhage (aSAH), especially in individuals treated aggressively in the early phase after ictus. Methods: We provided patients with aSAH with ultra-early definitive treatment, coiling or clipping, within 6 hours from arrival as per protocol. We classified the patients into 3 groups according to their computed tomography findings: Group 1, intraventricular hemorrhage with obstructive hydrocephalus; Group 2, massive intracerebral hemorrhage with brain herniation; and Group 3, neither Group 1 nor Group 2. We retrospectively evaluated patients with poor-grade aSAH who were admitted to our department between January 2013 and December 2016. We evaluated functional outcome at 6 months, defining modified Rankin Scale (mRS) scores of 0-2 as good and those of 3-6 as poor outcomes. Results: A good functional outcome was observed in 39.4% (28/71) of all cases. All-cause mortality at 6 months was 15.5% (11/71). A good outcome in Group 3 was significantly higher than that in the other two groups (Group 1 and 2 vs. Group 3, 20.8% vs. 48.9%, p = 0.02), even after adjustment with a multiple logistic regression analysis (odds ratio 6.1, 95% confidence interval 1.1 to 34.8). Conclusions: Approximately 40% of patients with poor-grade aSAH became functionally independent, and approximately half of the patients with poor-grade aSAH who had neither intraventricular hemorrhage with obstructive hydrocephalus nor with brain herniation had good functional outcomes. Although further trials are required to confirm our results, ultra-early surgery may be considered for patients with poor-grade aSAH.

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Section: Discussionmentioning

confidence: 99%

Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage

et al. 2019

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“…25 Most studies evaluating time to treatment and SAH involve aneurysmal SAH. [43][44][45] This is particularly important for patients who present to the ED with low GCS and high-risk TBI mechanism so that the diagnostic and therapeutic processes include initial resuscitation, CT scan, neurosurgery consultation, and transfer the operating room can be expedited. A second study found that the Stockholm and Helsinki CT scores performed better than the Rotterdam and Marshall CT scores.…”

Section: Severe Tbimentioning

confidence: 99%

Traumatic subarachnoid hemorrhage: a scoping review

Griswold

Fernández

Rubiano

2021

Preprint

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Sixty-nine million people suffer from traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (tSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. However, a limited number of studies evaluate recent trends in the diagnostic and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of traumatic subarachnoid hemorrhage. This scoping review was conducted following the JBI methodology for scoping reviews. The review included adults who suffered SAH secondary to trauma. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: tSAH associated with mild TBI (n=13), and severe TBI (n=3); clinical management and diagnosis (n=9); imaging (n=3); and 5) aneurysmal tSAH (n=1). Of the 30 studies, two came from a low-and middle-income country (LMIC); excluding China, nearly a high-income country. Patients with tSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be managed conservatively when considering ICU admission. The Helsinki and Stockholm CT scoring systems, in addition to the AIS, Cr, age decision tree, may be valuable tools to use when predicting outcome and mortality.

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“…Одним из изучаемых направлений совершенствования лечения пациентов с САК является концепция ультрараннего лечения -проведение хирургического или эндоваскулярного вмешательства в первые 24 ч после начала заболевания [22,23]. Основной его целью является минимизация риска повторного кровоизлияния.…”

Section: ультраранняя рентгенэндоваскулярная эмболизацияunclassified

Evaluation of the Efficiency of Ultra-Early Endovascular Embolization of Cerebral Aneurisms in Subarachnoid Hemorrage

Шалыгин

Gorbunov

Дергилев

et al. 2021

Vestn. rentgenol. radiol.

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РезюмеВ обзоре обсуждается эффективность рентгенэндоваскулярной эмболизации интракраниальных аневризм при субарахноидальном кровоизлиянии (САК) в первые 24 ч после разрыва. Необходимость данного исследования продиктована медико-социальной значимостью заболевания, в частности высокой степенью летальности и инвалидизации при САК аневризматического генеза, в том числе у молодых пациентов. Выбор сроков рентгенэндоваскулярной эмболизации при САК остается предметом дискуссии профессионального сообщества с момента внедрения метода в клиническую практику. Выполнение эмболизации в 1-е сутки с момента дебюта заболевания, так называемая ultra-early embolization (ультраранняя эмболизация), потенциально положительно влияет на исходы САК, снижая количество летальных случаев и увеличивая число благоприятных исходов. Основным преимуществом данной тактики является предотвращение повторного разрыва аневризмы, вероятность которого наиболее высока в 1-е сутки заболевания, а также возможность начала интенсивной терапии САК в самые ранние сроки. Ключевые слова: субарахноидальное кровоизлияние; церебральная аневризма; ультраранняя эндоваскулярная эмболизация; обзор. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

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Ultra-Early Treatment for Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Cited by 35 publications

References 29 publications

Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage

Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage

Traumatic subarachnoid hemorrhage: a scoping review

Evaluation of the Efficiency of Ultra-Early Endovascular Embolization of Cerebral Aneurisms in Subarachnoid Hemorrage

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