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

作者：Oudshoorn Simone C; Rinkel Gabriel J E; Molyneux Andrew J; Kerr Richard S; Mees Sanne M Dorhout; Backes Daan; Algra Ale; Vergouwen Mervyn D I^*

来源：Neurocritical Care, 2014, 21(1): 4-13.

DOI：10.1007/s12028-014-9969-8

• Subarachnoid hemorrhage
• Aneurysm
• Treatment
• Clipping
• Coil embolization
• Timing

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.
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.
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).
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.

• 出版日期2014-8