TY - JOUR
T1 - Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
AU - Vergouwen, Mervyn D.I.
AU - Germans, Menno R.
AU - Post, René
AU - Tjerkstra, Maud A.
AU - Coert, Bert A.
AU - Rinkel, Gabriel J.E.
AU - Peter Vandertop, William
AU - Verbaan, Dagmar
N1 - Funding Information:
MDIV was supported by a Clinical Established Investigator grant by the Dutch Heart Foundation (2018T076).
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The ULTRA trial was funded by Fonds NutsOhra (project number 1202-31).
Publisher Copyright:
© European Stroke Organisation 2023.
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - aneurysm
KW - clipping
KW - coiling
KW - endovascular treatment
KW - Subarachnoid hemorrhage
KW - timing
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85158903840&partnerID=8YFLogxK
U2 - 10.1177/23969873231173273
DO - 10.1177/23969873231173273
M3 - Article
C2 - 37641555
AN - SCOPUS:85158903840
SN - 2396-9873
VL - 8
SP - 802
EP - 807
JO - European Stroke Journal
JF - European Stroke Journal
IS - 3
ER -