Determinants of Poor Outcome After Aneurysmal Subarachnoid Hemorrhage when both Clipping and Coiling Are Available: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan

作者：Taki Waro^*; Sakai Nobuyuki; Suzuki Hidenori; Hyodo Akio; Nemoto Shigeru; Hyogo Toshio; Terada Tomoaki; Satoh Kouichi; Kuwayama Naoya; Miyachi Shigeru; Komiyama Masaki; Ezura Masayuki; Murayama Yuichi; Sakaida Hiroshi; Maeda Masayuki; Nagai Hiroshi; Kataoka Taketo; Ishihara Shoichiro; Koguchi Yorio; Kobayashi Shigeki; Enomoto Yukiko; Yamada Kiyofumi; Yoshimura Shinichi; Matsumoto Yasushi; Hirohata Masaru; Sakai Nobuyuki; Adachi Hidemitsu; Ueno Yasushi

来源：World Neurosurgery, 2011, 76(5): 437-445.

DOI：10.1016/j.wneu.2011.04.026

• Cerebral aneurysm
• Endovascular treatment
• Microsurgery
• Outcome
• Subarachnoid hemorrhage

OBJECTIVE: To examine current determinants of poor outcome after aneurysmal subarachnoid hemorrhage (SAH) when ruptured aneurysms are treated with either microsurgery (clipping) or endovascular treatment (coiling) depending on each patient's characteristics.
METHODS: Between March 2006 and February 2007, 534 patients with SAH were enrolled in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) project. Patients were treated according to the preference of investigators who were experienced in performing both clipping and coiling. Factors influencing poor outcome (12-month modified Rankin Scale [mRS], 3-6) were determined using multivariate logistic regression analyses.
RESULTS: In this cohort, 32.4% of patients were World Federation of Neurosurgical Societies (WFNS) grade IV-V, and 28.1% had a poor outcome. Clipping was preferably performed for small aneurysms with a wide neck and for middle cerebral artery (MCA) aneurysms, whereas coiling was preferred for larger, internal carotid artery (ICA) and posterior circulation aneurysms. In addition to increasing age, admission WFNS grade IV-V, preadmission aneurysmal rerupture, vasospasm-induced cerebral infarct, pneumonia, sepsis, shunt-dependent hydrocephalus and seizure, postclipping hemorrhagic complications (odds ratio 4.8, 95% confidence interval 1.5-15.3, P < 0.01), and postcoiling ischemic complications (odds ratio 4.4, 95% confidence interval 1.3-15.2, P < 0.05) significantly caused poor outcomes, although the complications did not affect mortality. Type of treatment modality and size and location of aneurysms did not influence outcome.
CONCLUSIONS: Introducing an endovascular treatment option has made aneurysm characteristics less important to outcome, but procedural complications are problematic and should be reduced to improve outcome.

• 出版日期2011-11