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.
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.
Authors: George Kwok Chu Wong; Ronald Boet; Stephanie Chi Ping Ng; Matthew Chan; Tony Gin; Benny Zee; Wai Sang Poon Journal: World Neurosurg Date: 2011-11-01 Impact factor: 2.104
Authors: E Sander Connolly; Alejandro A Rabinstein; J Ricardo Carhuapoma; Colin P Derdeyn; Jacques Dion; Randall T Higashida; Brian L Hoh; Catherine J Kirkness; Andrew M Naidech; Christopher S Ogilvy; Aman B Patel; B Gregory Thompson; Paul Vespa Journal: Stroke Date: 2012-05-03 Impact factor: 7.914
Authors: M Cronqvist; R Wirestam; B Ramgren; L Brandt; O Nilsson; H Säveland; S Holtås; E-M Larsson Journal: Neuroradiology Date: 2005-10-19 Impact factor: 2.804
Authors: Jordi de Winkel; Tim Y Cras; Ruben Dammers; Pieter-Jan van Doormaal; Mathieu van der Jagt; Diederik W J Dippel; Hester F Lingsma; Bob Roozenbeek Journal: BMC Neurol Date: 2022-06-30 Impact factor: 2.903
Authors: Airton Leonardo de Oliveira Manoel; Ann Mansur; Gisele Sampaio Silva; Menno R Germans; Blessing N R Jaja; Ekaterina Kouzmina; Thomas R Marotta; Simon Abrahamson; Tom A Schweizer; Julian Spears; R Loch Macdonald Journal: Neurocrit Care Date: 2016-12 Impact factor: 3.210
Authors: Reinier Wp Tack; Mervyn DI Vergouwen; Irene van der Schaaf; Albert van der Zwan; Gabriel Je Rinkel; Antti E Lindgren Journal: Eur Stroke J Date: 2019-02-01
Authors: Abdurehman Choudhry; Daniel Murray; Paula Corr; Deirdre Nolan; Deirdre Coffey; Stephen MacNally; Alan O'Hare; Sarah Power; Matthew Crockett; John Thornton; Daniel Rawluk; Paul Brennan; Mohsen Javadpour Journal: Ir J Med Sci Date: 2021-02-18 Impact factor: 1.568
Authors: Inez Koopman; Jacoba P Greving; Irene C van der Schaaf; Albert van der Zwan; Gabriel Je Rinkel; Mervyn DI Vergouwen Journal: Eur Stroke J Date: 2018-10-08
Authors: Sean N Neifert; Emily K Chapman; Michael L Martini; William H Shuman; Alexander J Schupper; Eric K Oermann; J Mocco; R Loch Macdonald Journal: Transl Stroke Res Date: 2020-10-19 Impact factor: 6.829
Authors: Airton Leonardo de Oliveira Manoel; Alberto Goffi; Tom R Marotta; Tom A Schweizer; Simon Abrahamson; R Loch Macdonald Journal: Crit Care Date: 2016-01-23 Impact factor: 9.097