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Microsurgical treatment of ruptured aneurysms beyond 72 hours after rupture: implications for advanced management

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Aneurysmal subarachnoid hemorrhage (aSAH) patients admitted to primary stroke centers are often transferred to neurosurgical and endovascular services at tertiary centers. The effect on microsurgical outcomes of the resultant delay in treatment is unknown. We evaluated microsurgical aSAH treatment > 72 h after the ictus.

Methods

All aSAH patients treated at a single tertiary center between August 1, 2007, and July 31, 2019, were retrospectively reviewed. The additional inclusion criterion was the availability of treatment data relative to time of bleed. Patients were grouped based on bleed-to-treatment time as having acute treatment (on or before postbleed day [PBD] 3) or delayed treatment (on or after PBD 4). Propensity adjustments were used to correct for statistically significant confounding covariables.

Results

Among 956 aSAH patients, 92 (10%) received delayed surgical treatment (delayed group), and 864 (90%) received acute endovascular or surgical treatment (acute group). Reruptures occurred in 3% (26/864) of the acute group and 1% (1/92) of the delayed group (p = 0.51). After propensity adjustments, the odds of residual aneurysm (OR = 0.09; 95% CI = 0.04–0.17; p < 0.001) or retreatment (OR = 0.14; 95% CI = 0.06–0.29; p < 0.001) was significantly lower among the delayed group. The OR was 0.50 for rerupture, after propensity adjustments, in the delayed setting (p = 0.03). Mean Glasgow Coma Scale scores at admission in the acute and delayed groups were 11.5 and 13.2, respectively (p < 0.001).

Conclusions

Delayed microsurgical management of aSAH, if required for definitive treatment, appeared to be noninferior with respect to retreatment, residual, and rerupture events in our cohort after adjusting for initial disease severity and significant confounding variables.

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Abbreviations

aSAH:

Aneurysmal subarachnoid hemorrhage

CI:

Confidence interval

CSC:

Comprehensive stroke center

GCS:

Glasgow Coma Scale

mRS:

Modified Rankin Scale

OR:

Odds ratio

PBD:

Postbleed day

SD:

Standard deviation

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Acknowledgements

We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation.

Funding

No funding was received for this research.

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Author notes

  1. Visish M. Srinivasan and Stefan W. Koester contributed equally.

Authors and Affiliations

  1. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Visish M. Srinivasan, Stefan W. Koester, Katherine Karahalios, Candice L. Nguyen, Kavelin Rumalla, Joshua S. Catapano, Redi Rahmani, Mohamed A. Labib, Andrew F. Ducruet, Felipe C. Albuquerque & Michael T. Lawton

Authors
  1. Visish M. Srinivasan
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  2. Stefan W. Koester
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  3. Katherine Karahalios
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  4. Candice L. Nguyen
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  5. Kavelin Rumalla
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  6. Joshua S. Catapano
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  8. Mohamed A. Labib
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  10. Felipe C. Albuquerque
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  11. Michael T. Lawton
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Stefan W. Koester and Candice L. Nguyen. The first draft of the manuscript was written by Stefan W. Koester and Visish M. Srinivasan and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael T. Lawton.

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Ethics approval

This retrospective study was approved by the Institutional Review Board and St. Joseph’s Hospital and Medical Center in Phoenix, Arizona.

Informed consent

Informed consent was waived due to the low risk to patients in this IRB-approved, retrospective study.

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The authors declare no conflict of interest.

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This article is part of the Topical Collection on Vascular Neurosurgery – Aneurysm

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Srinivasan, V.M., Koester, S.W., Karahalios, K. et al. Microsurgical treatment of ruptured aneurysms beyond 72 hours after rupture: implications for advanced management. Acta Neurochir 164, 2431–2439 (2022). https://doi.org/10.1007/s00701-022-05283-x

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  • DOI: https://doi.org/10.1007/s00701-022-05283-x

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