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Aneurysm Treatment <24 Versus 24–72 h After Subarachnoid Hemorrhage

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Abstract

Introduction

In patients with aneurysmal subarachnoid hemorrhage (aSAH), it is unclear whether aneurysm treatment <24 h after ictus results in better outcomes than treatment 24–72 h after aSAH. We studied whether aneurysm occlusion <24 h is associated with better outcomes than occlusion 24–72 h after aSAH.

Methods

We used two cohorts of patients with aSAH: (1) the UMC Utrecht cohort with patients admitted between 2008 and 2012 and (2) the International Subarachnoid Aneurysm Trial cohort. Aneurysm treatment was categorized into <24 h and 24–72 h after ictus. We calculated adjusted risk ratios (aRRs) with 95 % confidence intervals (CIs) using Poisson regression analyses for poor functional outcome (death or dependency) for both cohorts separately, and performed a pooled analysis based on individual patient data. We also performed a worst-case scenario analysis wherein all patients with rebleeding >3 h after admission were re-categorized into the group with aneurysm treatment 24–72 h after aSAH.

Results

We included 1,238 patients (UMC Utrecht cohort: n = 330; ISAT: n = 908). The aRR for poor outcome after treatment <24 h was in the UMC Utrecht cohort 1.84 (95 % CI: 1.25-2.70), in ISAT 1.14 (95 % CI 0.84–1.55), in the pooled analysis 1.37 (95 % CI 1.11–1.68), and in the worst-case scenario pooled analysis 1.24 (95 % CI 1.01–1.52).

Conclusion

Our results suggest that aneurysm occlusion can be performed in day time within 72 h after ictus, instead of on an emergency basis. However, due to the retrospective, non-randomized design of our study, our results cannot be considered as definitive evidence.

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Acknowledgments

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Funding

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Conflict of interest

Andrew Molyneux reports a consulting agreement with Sequent Medical Inc. All other authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room G03-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Simone C. Oudshoorn, Gabriel J. E. Rinkel, Sanne M. Dorhout Mees, Daan Backes, Ale Algra & Mervyn D. I. Vergouwen

  2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Ale Algra

  3. Neurovascular Research Unit, Nuffield Department of Surgery, University of Oxford, Oxford, UK

    Andrew J. Molyneux & Richard S. Kerr

  4. Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK

    Andrew J. Molyneux & Richard S. Kerr

Authors
  1. Simone C. Oudshoorn
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  2. Gabriel J. E. Rinkel
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  3. Andrew J. Molyneux
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  4. Richard S. Kerr
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  5. Sanne M. Dorhout Mees
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  6. Daan Backes
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  7. Ale Algra
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  8. Mervyn D. I. Vergouwen
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Correspondence to Mervyn D. I. Vergouwen.

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Oudshoorn, S.C., Rinkel, G.J.E., Molyneux, A.J. et al. Aneurysm Treatment <24 Versus 24–72 h After Subarachnoid Hemorrhage. Neurocrit Care 21, 4–13 (2014). https://doi.org/10.1007/s12028-014-9969-8

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  • DOI: https://doi.org/10.1007/s12028-014-9969-8

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