Comparison of the timing of intervention and treatment modality of poor-grade aneurysmal subarachnoid hemorrhage
| Autor: | Tomasz Tykocki, Bogusław Kostkiewicz, Małgorzata Machaj, Dorota Szydlarska, Marcin Czyz |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Subarachnoid hemorrhage genetic structures Endovascular therapy 03 medical and health sciences 0302 clinical medicine Aneurysm Risk Factors Intervention (counseling) Medicine Humans Poor grade cardiovascular diseases 030212 general & internal medicine Aged business.industry Endovascular Procedures General Medicine Middle Aged Subarachnoid Hemorrhage medicine.disease Prognosis Surgery Early Diagnosis Treatment Outcome Treatment modality Subarachnoid haemorrhage Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | British journal of neurosurgery. 31(4) |
| ISSN: | 1360-046X |
| Popis: | The timing and modality of intervention in the treatment of poor-grade aneurysmal subarachnoid haemorrhage (aSAH) has not been defined. The purpose of the study is to analyse whether early treatment and type of intervention influence the clinical outcomes of poor-grade aSAH patients.Patients with poor-grade aSAH were retrieved. Demographics, Fisher grade, radiological characteristics and clinical outcomes were recorded. Outcomes were compared using the modified Rankin Scale (mRS), for groups treated early within 24 hours of aSAH or later and by clipping or endovascular therapy. Multivariate multiple regression model and logistic regression were used to assess factors affecting outcomes at discharge in mRS and length of stay.The study was conducted on 79 patients. 47 (59%) were treated by clipping, 38 (48%) received intervention within 24 hours of aSAH. Patients treated24h had significantly lower mortality (n = 5; 13% vs. n = 14; 37%; p .023), higher rate of 0-3 mRS (n = 22;58% vs. n = 9; 22%; p .039) and were younger (49.5 ± 6.1 vs. 65.8 ± 7.4 years; p .038). There were no significant differences in mRS between clipping and endovascular therapy. Predictors of length of stay were ICH, MLS, endovascular therapy, location in posterior circulation, Fisher grade and time to intervention24h. Early intervention,24h significantly influenced the favourable results in mRS (0-3); (OR 4,14; Cl95% 3.82-4.35). Posterior circulation aneurysms, midline shift and intracerebral hematoma were correlated with poor outcomes.Early treatment, within 24 h, of poor-grade aSAH confirmed better clinical outcome compared to later aneurysm securement. There was no significant difference between clipping and endovascular treatment. |
| Databáze: | OpenAIRE |
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