Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage
| Autor: | Shosei Tani, Kyoko Unemoto, Saori Kudo, Kentaro Kuwamoto, Chie Tanaka, Akiko Kitahashi, Ami Shibata, Takashi Tagami, Hiroyuki Yokota, Junya Kaneko, Shin Sato |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Subarachnoid hemorrhage Computed Tomography Angiography Aneurysm Ruptured Severity of Illness Index Brain herniation 03 medical and health sciences 0302 clinical medicine Aneurysm Modified Rankin Scale Humans Medicine Aged Retrospective Studies Intracerebral hemorrhage business.industry Recovery of Function General Medicine Odds ratio Middle Aged Subarachnoid Hemorrhage medicine.disease Confidence interval Surgery Treatment Outcome Intraventricular hemorrhage 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Tomography X-Ray Computed business Vascular Surgical Procedures |
| Zdroj: | Journal of Nippon Medical School. 86:81-90 |
| ISSN: | 1347-3409 1345-4676 |
| DOI: | 10.1272/jnms.jnms.2019_86-203 |
| Popis: | Background Little is known regarding functional outcome following poor-grade (World Federation of Neurosurgical Societies grades IV and V) aneurysmal subarachnoid hemorrhage (aSAH), especially in individuals treated aggressively in the early phase after ictus. Methods We provided patients with aSAH with ultra-early definitive treatment, coiling or clipping, within 6 hours from arrival as per protocol. We classified the patients into 3 groups according to their computed tomography findings: Group 1, intraventricular hemorrhage with obstructive hydrocephalus; Group 2, massive intracerebral hemorrhage with brain herniation; and Group 3, neither Group 1 nor Group 2. We retrospectively evaluated patients with poor-grade aSAH who were admitted to our department between January 2013 and December 2016. We evaluated functional outcome at 6 months, defining modified Rankin Scale (mRS) scores of 0-2 as good and those of 3-6 as poor outcomes. Results A good functional outcome was observed in 39.4% (28/71) of all cases. All-cause mortality at 6 months was 15.5% (11/71). A good outcome in Group 3 was significantly higher than that in the other two groups (Group 1 and 2 vs. Group 3, 20.8% vs. 48.9%, p = 0.02), even after adjustment with a multiple logistic regression analysis (odds ratio 6.1, 95% confidence interval 1.1 to 34.8). Conclusions Approximately 40% of patients with poor-grade aSAH became functionally independent, and approximately half of the patients with poor-grade aSAH who had neither intraventricular hemorrhage with obstructive hydrocephalus nor with brain herniation had good functional outcomes. Although further trials are required to confirm our results, ultra-early surgery may be considered for patients with poor-grade aSAH. |
| Databáze: | OpenAIRE |
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