Patterns of care for ruptured aneurysms of the middle cerebral artery: analysis of a Swiss national database (Swiss SOS).

Autor:	Maldaner N; 1Department of Neurosurgery, Kantonsspital St. Gallen., Steinsiepe VK; 1Department of Neurosurgery, Kantonsspital St. Gallen., Goldberg J; 2Department of Neurosurgery, University Hospital Bern., Fung C; 2Department of Neurosurgery, University Hospital Bern.; 13Department of Neurosurgery, University Hospital Freiburg, University of Freiburg, Germany., Bervini D; 2Department of Neurosurgery, University Hospital Bern., May A; 3Department of Neurosurgery, University Clinic Geneva., Bijlenga P; 3Department of Neurosurgery, University Clinic Geneva., Schaller K; 3Department of Neurosurgery, University Clinic Geneva., Roethlisberger M; 4Department of Neurosurgery, Basel University Hospital., Zumofen DW; 4Department of Neurosurgery, Basel University Hospital., D'Alonzo D; 5Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel.; 6Department of Neurosurgery, Kantonsspital Aarau., Marbacher S; 5Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel.; 6Department of Neurosurgery, Kantonsspital Aarau., Fandino J; 5Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel.; 6Department of Neurosurgery, Kantonsspital Aarau., Maduri R; 7Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland., Daniel RT; 7Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland., Burkhardt JK; 8Department of Neurosurgery, Baylor College of Medicine, Houston, Texas., Chiappini A; 8Department of Neurosurgery, Baylor College of Medicine, Houston, Texas., Robert T; 9Department of Neurosurgery, Ospedale Regionale di Lugano, Switzerland., Schatlo B; 10Department of Neurosurgery, University Hospital Göttingen, Germany., Seule MA; 1Department of Neurosurgery, Kantonsspital St. Gallen., Weyerbrock A; 1Department of Neurosurgery, Kantonsspital St. Gallen., Regli L; 11Department of Neurosurgery, University Hospital Zurich.; 12Clinical Neuroscience Center, University of Zurich, Switzerland; and., Stienen MN; 11Department of Neurosurgery, University Hospital Zurich.; 12Clinical Neuroscience Center, University of Zurich, Switzerland; and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2019 Nov 15; Vol. 133 (6), pp. 1811-1820. Date of Electronic Publication: 2019 Nov 15 (Print Publication: 2020).
DOI:	10.3171/2019.9.JNS192055
Abstrakt:	Objective: The objective of this study was to determine patterns of care and outcomes in ruptured intracranial aneurysms (IAs) of the middle cerebral artery (MCA) in a contemporary national cohort. Methods: The authors conducted a retrospective analysis of prospective data from a nationwide multicenter registry of all aneurysmal subarachnoid hemorrhage (aSAH) cases admitted to a tertiary care neurosurgical department in Switzerland in the years 2009-2015 (Swiss Study on Aneurysmal Subarachnoid Hemorrhage [Swiss SOS]). Patterns of care and outcomes at discharge and the 1-year follow-up in MCA aneurysm (MCAA) patients were analyzed and compared with those in a control group of patients with IAs in locations other than the MCA (non-MCAA patients). Independent predictors of a favorable outcome (modified Rankin Scale score ≤ 3) were identified, and their effect size was determined. Results: Among 1866 consecutive aSAH patients, 413 (22.1%) harbored an MCAA. These MCAA patients presented with higher World Federation of Neurosurgical Societies grades (p = 0.007), showed a higher rate of concomitant intracerebral hemorrhage (ICH; 41.9% vs 16.7%, p < 0.001), and experienced delayed cerebral ischemia (DCI) more frequently (38.9% vs 29.4%, p = 0.001) than non-MCAA patients. After adjustment for confounders, patients with MCAA were as likely as non-MCAA patients to experience DCI (aOR 1.04, 95% CI 0.74-1.45, p = 0.830). Surgical treatment was the dominant treatment modality in MCAA patients and at a significantly higher rate than in non-MCAA patients (81.7% vs 36.7%, p < 0.001). An MCAA location was a strong independent predictor of surgical treatment (aOR 8.49, 95% CI 5.89-12.25, p < 0.001), despite statistical adjustment for variables traditionally associated with surgical treatment, such as (space-occupying) ICH (aOR 1.73, 95% CI 1.23-2.45, p = 0.002). Even though MCAA patients were less likely to die during the acute hospitalization (aOR 0.52, 0.30-0.91, p = 0.022), their rate of a favorable outcome was lower at discharge than that in non-MCAA patients (55.7% vs 63.7%, p = 0.003). At the 1-year follow-up, 68.5% and 69.6% of MCAA and non-MCAA patients, respectively, had a favorable outcome (p = 0.676). Conclusions: Microsurgical occlusion remains the predominant treatment choice for about 80% of ruptured MCAAs in a European industrialized country. Although patients with MCAAs presented with worse admission grades and greater rates of concomitant ICH, in-hospital mortality was lower and long-term disability was comparable to those in patients with non-MCAA.
Databáze:	MEDLINE
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