Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To describe features in patients admitted to the intensive care unit (ICU) for poor-grade aneurysmal subarachnoid hemorrhage (SAH) and to identify predictors of 12-month outcome.
We conducted a controlled observational study of 51 consecutive patients treated with endovascular coiling within 96 h of rupture for poor-grade aneurysmal SAH (20 men and 31 women, age 54 ± 12 years). We recorded co-morbidities; initial severity; aneurysm location; occurrence of acute hydrocephalus, initial seizures, and/or neurogenic lung edema; troponin values, Fisher grade; computed tomography (CT) findings; treatment intensity; and occurrence of vasospasm. The brain injury marker S100B was assayed daily over the first 8 days. Glasgow Outcome Scores (GOS) were recorded at ICU discharge, at 6 and 12 months. The main outcome criterion was the 1-year GOS score, which we used to classify patients as having a poor outcome (GOS 1–3) or a good outcome (GOS 4–5).
Overall, clinical status after 1 year was very good (GOS 5) in 41% of patients and good (GOS 4) in 16%. Neither baseline characteristics nor interventions differed significantly between patients with good outcome (GOS 4–5) and those with poor outcome (GOS 1–3). Persistent intracranial pressure elevation and higher mean 8-day S100B value significantly and independently predicted the 1-year GOS outcome (P = 0.008 and P = 0.001, respectively).
Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1–3) after 1 year.
- Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand: incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke 2000;31(8):1843–50.
- Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 1997;28(3):660–4.
- Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968;28(1):14–20.
- Drake C. Report of world federation of neurological surgeons comittee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 1988;68:985–6.
- Rosen DS, Macdonald RL. Grading of subarachnoid hemorrhage: modification of the World Federation of Neurosurgical Societies scale on the basis of data for a large series of patients. Neurosurgery 2004;54(3):566–75; discussion 75–6.
- Molyneux A, Kerr R, Stratton I, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360(9342):1267–74. CrossRef
- van der Schaaf I, Algra A, Wermer M, et al. Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2005(4):CD003085.
- Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270(24):2957–63. CrossRef
- Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6(1):1–9. CrossRef
- Korinek AM, Reina M, Boch AL, Rivera AO, De Bels D, Puybasset L. Prevention of external ventricular drain-related ventriculitis. Acta Neurochir (Wien) 2005;147(1):39–45; discussion 6.
- Okada Y, Shima T, Nishida M, et al. Comparison of transcranial Doppler investigation of aneurysmal vasospasm with digital subtraction angiographic and clinical findings. Neurosurgery 1999;45(3):443–9; discussion 9–50.
- Biondi A, Ricciardi GK, Puybasset L, et al. Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. AJNR Am J Neuroradiol 2004;25(6):1067–76.
- Arakawa Y, Kikuta K, Hojo M, Goto Y, Ishii A, Yamagata S. Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases. Neurosurgery 2001;48(4):723–8; discussion 8–30.
- Weiss N, Sanchez-Pena P, Roche S, et al. Prognosis value of plasma S100B protein levels after subarachnoid aneurysmal hemorrhage. Anesthesiology 2006;104(4):658–66. CrossRef
- Sznajder M, Leleu G, Buonamico G, et al. Estimation of direct cost and resource allocation in intensive care: correlation with Omega system. Intensive Care Med 1998;24(6):582–9. CrossRef
- Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1(7905):480–4. CrossRef
- Lannoo E, Van Rietvelde F, Colardyn F, et al. Early predictors of mortality and morbidity after severe closed head injury. J Neurotrauma 2000;17(5):403–14.
- Marmarou A, Saad A, Aygok G, Rigsbee M. Contribution of raised ICP and hypotension to CPP reduction in severe brain injury: correlation to outcome. Acta Neurochir Suppl 2005;95:277–80.
- Heuer GG, Smith MJ, Elliott JP, Winn HR, LeRoux PD. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2004;101(3):408–16.
- Mack WJ, King RG, Ducruet AF, et al. Intracranial pressure following aneurysmal subarachnoid hemorrhage: monitoring practices and outcome data. Neurosurg Focus 2003;14(4):e3.
- Sarrafzadeh AS, Thomale UW, Haux D, Unterberg AW. Cerebral metabolism and intracranial hypertension in poor grade aneurysmal subarachnoid haemorrhage patients. Acta Neurochir Suppl 2005;95:89–92. CrossRef
- Eide PK, Sorteberg W. Intracranial pressure levels and single wave amplitudes, Glasgow Coma Score and Glasgow Outcome Score after subarachnoid haemorrhage. Acta Neurochir (Wien) 2006;148:1267–76.
- Sen J, Belli A, Petzold A, et al. Extracellular fluid S100B in the injured brain: a future surrogate marker of acute brain injury? Acta Neurochir (Wien) 2005;147(8):897–900. CrossRef
- Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcome of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 2000;31(10):2369–77.
- Murayama Y, Malisch T, Guglielmi G, et al. Incidence of cerebral vasospasm after endovascular treatment of acutely ruptured aneurysms: report on 69 cases. J Neurosurg 1997;87(6):830–5. CrossRef
- Vanninen R, Koivisto T, Saari T, Hernesniemi J, Vapalahti M. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils-a prospective randomized study. Radiology 1999;211(2):325–36.
- Kremer C, Groden C, Hansen HC, Grzyska U, Zeumer H. Outcome after endovascular treatment of Hunt and Hess grade IV or V aneurysms: comparison of anterior versus posterior circulation. Stroke 1999;30(12):2617–22.
- Miyaoka M, Sato K, Ishii S. A clinical study of the relationship of timing to outcome of surgery for ruptured cerebral aneurysms. A retrospective analysis of 1622 cases. J Neurosurg 1993;79(3):373–8.
- Bailes JE, Spetzler RF, Hadley MN, Baldwin HZ. Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 1990;72(4):559–66. CrossRef
- Wilby MJ, Sharp M, Whitfield PC, Hutchinson PJ, Menon DK, Kirkpatrick PJ. Cost-effective outcome for treating poor-grade subarachnoid hemorrhage. Stroke 2003;34(10):2508–11. CrossRef
- Langfitt TW, Kassell NF, Weinstein JD. Cerebral blood flow with intracranial hypertension. Neurology 1965;15:761–73.
- Lee KC, Huh SK, Park HS, Shin YS, Lee KS. Management of poor-grade patients with ruptured intracranial aneurysm. Keio J Med 1997;46(2):69–73.
- Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage: a review. Neurosurgery 2005;56(4):633–54; discussion 54.
- Groden C, Kremer C, Regelsberger J, Hansen HC, Zeumer H. Comparison of operative and endovascular treatment of anterior circulation aneurysms in patients in poor grades. Neuroradiology 2001;43(9):778–83. CrossRef
- Johansson M, Norback O, Gal G, et al. Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage. Neuroradiology 2004;46(5):385–91. CrossRef
- Jain R, Deveikis J, Thompson BG. Endovascular management of poor-grade aneurysmal subarachnoid hemorrhage in the geriatric population. AJNR Am J Neuroradiol 2004;25(4):596–600.
- Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage
Volume 7, Issue 1 , pp 18-26
- Cover Date
- Print ISSN
- Online ISSN
- Humana Press Inc
- Additional Links
- Intracranial aneurysms
- Subarachnoid hemorrhage
- Poor-grade subarachnoid hemorrhage
- Industry Sectors
- Author Affiliations
- 1. Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France
- 2. Department of Neuroradiology, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France
- 3. Department of Neurosurgery, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France
- 4. Département d’Anesthésie-Réanimation, Hôpital de la Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013, Paris, France