Acute endovascular treatment of ruptured aneurysms in poor-grade patients.

We reviewed the 6-month outcome of 45 consecutive patients in poor grade treated acutely by coiling after subarachnoid haemorrhage (SAH). About half had a favourable outcome, a promising result in accordance with some surgical and endovascular reports proposing early aggressive treatment of an aneurysm causing SAH. The poor clinical grade, due to parenchyma damage from the SAH, remains the main prognostic factor, rebleeding from the untreated aneurysm being only one cause of poor outcome. It is therefore difficult to isolate the impact of any treatment of the aneurysm on outcome, and unavoidable selection bias may strongly influence favourable results. Nevertheless, available evidence and the limited invasiveness suggest that acute endovascular treatment is reasonable in these patients.