Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage

Mervyn D.I. Vergouwen*, Menno R. Germans, René Post, Maud A. Tjerkstra, Bert A. Coert, Gabriel J.E. Rinkel, William Peter Vandertop, Dagmar Verbaan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: The risk of rebleeding after aneurysmal subarachnoid hemorrhage (aSAH) is the highest during the initial hours after rupture. Emergency aneurysm treatment may decrease this risk, but is a logistic challenge and economic burden. We aimed to investigate whether aneurysm treatment <6 h after rupture is associated with a decreased risk of poor functional outcome compared to aneurysm treatment 6–24 h after rupture. Methods: We used data of patients included in the ULTRA trial (NCT02684812). All patients in ULTRA were admitted within 24 h after aneurysm rupture. For the current study, we excluded patients in whom the aneurysm was not treated <24 h after rupture. We calculated crude and adjusted risk ratios (aRR) with 95% confidence intervals using Poisson regression analyses for poor functional outcome (death or dependency, assessed by the modified Rankin Scale) after aneurysm treatment <6 h versus 6–24 h after rupture. Adjustments were made for age, sex, clinical condition on admission (WFNS scale), amount of extravasated blood (Fisher score), aneurysm location, tranexamic acid treatment, and aneurysm treatment modality. Results: We included 497 patients. Poor outcome occurred in 63/110 (57%) patients treated within 6 h compared to 145/387 (37%) patients treated 6–24 h after rupture (crude RR: 1.53, 95% CI: 1.24–1.88; adjusted RR: 1.36, 95% CI: 1.11–1.66). Conclusion: Aneurysm treatment <6 h is not associated with better functional outcome than aneurysm treatment 6–24 h after rupture. Our results do not support a strategy aiming to treat every patient with a ruptured aneurysm <6 h after rupture.

Original languageEnglish
Pages (from-to)802-807
Number of pages6
JournalEuropean Stroke Journal
Volume8
Issue number3
DOIs
Publication statusPublished - Sept 2023

Keywords

  • aneurysm
  • clipping
  • coiling
  • endovascular treatment
  • Subarachnoid hemorrhage
  • timing
  • treatment

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