Lukas Goertz1, Muriel Pflaeging1, Christina Hamisch1, Christoph Kabbasch2, Lenhard Pennig2, Niklas von Spreckelsen1,3, Kai Laukamp2,4, Marco Timmer1, Roland Goldbrunner1, Gerrit Brinker1, Boris Krischek1. 1. 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and. 2. 2Institute for Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, University of Cologne, Germany. 3. 3Department of Neurosurgery, Harvey Cushing Neuro-Oncology Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and. 4. 4Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Abstract
OBJECTIVE: Timely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome. METHODS: In this retrospective study, consecutive aSAH patients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics. RESULTS: Among 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHA patients were significantly younger (52 ± 11 vs 56 ± 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societies scores (p < 0.01) than EHA patients. In 54.5% of the cases, DHA patients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable outcome at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHA patients (62.3%) received conventional coiling more often than EHA patients (41.5%) (p = 0.03). CONCLUSIONS: DHA patients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.
OBJECTIVE: Timely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome. METHODS: In this retrospective study, consecutive aSAHpatients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics. RESULTS: Among 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHApatients were significantly younger (52 ± 11 vs 56 ± 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societies scores (p < 0.01) than EHApatients. In 54.5% of the cases, DHApatients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable outcome at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHApatients (62.3%) received conventional coiling more often than EHApatients (41.5%) (p = 0.03). CONCLUSIONS:DHApatients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.
Authors: Adnan I Qureshi; Samiat Agunbiade; Wei Huang; Iqra N Akhtar; Michael G Abraham; Naveed Akhtar; Fawaz Al-Mufti; Emrah Aytac; Ferhat Balgetir; Mikayel Grigoryan; Camilo R Gomez; Ameer E Hassan; Vishal Jani; Nazli A Janjua; Liqun Jiao; Rakesh Khatri; Jawad F Kirmani; Adam Kobayashi; Osman Kozak; Jun Lee; Iryna Lobanova; Ossama Yassin Mansour; Alberto Maud; Mikael Mazighi; Michel Piotin; Gustavo J Rodriguez; Farhan Siddiq; M Fareed K Suri; Wondwossen G Tekle Journal: J Neuroimaging Date: 2020-11-23 Impact factor: 2.324