Arianna Rustici1, Ciro Princiotta2, Corrado Zenesini3, Carlo Bortolotti4, Carmelo Sturiale4, Massimo Dall'olio2, Marco Leonardi5, Luigi Cirillo6,2. 1. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy. 2. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy. 3. IRCCS Istituto delle Scienze Neurologiche di Bologna, Servizio di Epidemiologia e Biostatistica, Bologna, Italy. 4. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy. 5. University of Bologna - Alma Mater Studiorum, Bologna, Italy. 6. Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy - luigi.cirillo2@unibo.it.
Abstract
BACKGROUND: In many clinical trials endovascular procedures are suggested as the treatment of choice for aneurysmal Subarachnoid Hemorrhage (aSAH) whenever possible. However, in clinical practice this management is often controversial. The aim of this study was to analyze factors involved in this decision. METHODS: Our study included 317 consecutive cases of aSAH between 2010 and 2016, assessing clinical and neuroradiological features to evaluate their role in this choice. RESULTS: In our series coiling was preferred in 119 (37.6%) patients, while 198 (62.4%) were treated surgically. On univariate analysis location of aneurysms (P<0.001), GCS score on admission (P=0.105), degree of midline shift (P=0.015), Fisher' score (P=0.002) and presence of vessels in the aneurysmal neck (P=0.071) proved the most relevant factors in the choice. Also, multivariate analysis confirmed the location and Fisher' grade as influential factors. Conversely, other radiological parameters, such as morphology, aspect and dome-neck ratio, presence of pre-operative vasospasm or hydrocephalus were not associated with this decision. CONCLUSIONS: The decision process in aSAH requires a multidisciplinary team, to singularly evaluate each patient. We found that the location of aneurysms in vertebro-basilar circulation, PcomA and ICA, greater GCS score, absence of vessels in the aneurysmal neck, lower midline shift and Fisher' score are factors influencing in choosing coiling. Conversely, morphology, Aspect and Dome-Neck ratio proved not relevant to this decision, due to technological improvement and increasing skills in the endovascular treatment.
BACKGROUND: In many clinical trials endovascular procedures are suggested as the treatment of choice for aneurysmal Subarachnoid Hemorrhage (aSAH) whenever possible. However, in clinical practice this management is often controversial. The aim of this study was to analyze factors involved in this decision. METHODS: Our study included 317 consecutive cases of aSAH between 2010 and 2016, assessing clinical and neuroradiological features to evaluate their role in this choice. RESULTS: In our series coiling was preferred in 119 (37.6%) patients, while 198 (62.4%) were treated surgically. On univariate analysis location of aneurysms (P<0.001), GCS score on admission (P=0.105), degree of midline shift (P=0.015), Fisher' score (P=0.002) and presence of vessels in the aneurysmal neck (P=0.071) proved the most relevant factors in the choice. Also, multivariate analysis confirmed the location and Fisher' grade as influential factors. Conversely, other radiological parameters, such as morphology, aspect and dome-neck ratio, presence of pre-operative vasospasm or hydrocephalus were not associated with this decision. CONCLUSIONS: The decision process in aSAH requires a multidisciplinary team, to singularly evaluate each patient. We found that the location of aneurysms in vertebro-basilar circulation, PcomA and ICA, greater GCS score, absence of vessels in the aneurysmal neck, lower midline shift and Fisher' score are factors influencing in choosing coiling. Conversely, morphology, Aspect and Dome-Neck ratio proved not relevant to this decision, due to technological improvement and increasing skills in the endovascular treatment.
Authors: Arianna Rustici; Elena Merli; Sabina Cevoli; Marco Di Donato; Giulia Pierangeli; Valentina Favoni; Carlo Bortolotti; Carmelo Sturiale; Pietro Cortelli; Luigi Cirillo Journal: Interv Neuroradiol Date: 2020-12-10 Impact factor: 1.610
Authors: I Capelli; M Zoli; M Righini; L Faccioli; V Aiello; L Spinardi; D Gori; F Friso; A Rustici; C Bortolotti; C Graziano; V Mantovani; N Sciascia; D Mazzatenta; M Seri; M Pastore Trossello; G La Manna Journal: Clin Neuroradiol Date: 2021-09-29 Impact factor: 3.649