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de Oliveira Manoel AL, Mansur A, Silva GS, Germans MR, Jaja BNR, Kouzmina E, Marotta TR, Abrahamson S, Schweizer TA, Spears J, Macdonald RL. Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review. Neurocrit Care 2017; 25:338-350. [PMID: 27651379 DOI: 10.1007/s12028-016-0305-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Poor-grade subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies grade 4 and 5) is associated with high mortality rates and unfavorable functional outcomes. We report a single-center cohort of poor-grade SAH patients, combined with a systematic review of studies reporting functional outcome in the poor-grade SAH population. METHODS Data on a cohort of poor-grade SAH patients treated between 2009 and 2013 were retrospectively collected and combined with a systematic review (from inception to November 2015; PubMed, Embase). Two reviewers assessed the studies independently based on predefined inclusion criteria: consecutive poor-grade SAH, functional outcome measured at least 3 months after hemorrhage, and the report of patients who died before aneurysm treatment. RESULTS The search yielded 329 publications, and 23 met our inclusion criteria with 2713 subjects enrolled from 1977 to 2014 in 10 countries (including 179 poor-grade patients from our cohort). Mortality rate was 60 % (1683 patients), of which 806 (29 %) died before and 877 (31 %) died after aneurysm treatment, respectively. Treatment was undertaken in 1775 patients (1775/2826-63 %): 1347 by surgical clipping (1347/1775-76 %) and 428 (428/1775-24 %) by endovascular methods. Outcome was favorable in 794 patients (28 %) and unfavorable in 1867 (66 %). When the studies were grouped into decades, favorable outcome increased from 13 % in the late 1970s to early 1980s to 35 % in the late 1980s to early 1990s, and remained unchanged thereafter. CONCLUSION Although mortality remains high in poor-grade SAH patients, a favorable functional outcome can be achieved in approximately one-third of patients. The development of new diagnostic methods and implementation of therapeutic approaches were probably responsible for the decrease in mortality and improvement in the functional outcome from 1970 to the 1990s. The plateau in functional outcome seen thereafter might be explained by the treatment of sicker and older patients and by the lack of new therapeutic interventions specific for SAH.
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Affiliation(s)
- Airton Leonardo de Oliveira Manoel
- Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, 3-141 CC, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada. .,Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Ann Mansur
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gisele Sampaio Silva
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto Israelita de Pesquisa Albert Einstein, Neurology Program, São Paulo, Brazil
| | - Menno R Germans
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Blessing N R Jaja
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Ekaterina Kouzmina
- Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, 3-141 CC, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Thomas R Marotta
- Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, 3-141 CC, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Simon Abrahamson
- Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Julian Spears
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - R Loch Macdonald
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Das KK, Singh S, Sharma P, Mehrotra A, Bhaisora K, Sardhara J, Srivastava AK, Jaiswal AK, Behari S, Kumar R. Results of Proactive Surgical Clipping in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Pattern of Recovery and Predictors of Outcome. World Neurosurg 2017; 102:561-570. [DOI: 10.1016/j.wneu.2017.03.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 12/27/2022]
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Kranthi S, Sahu BP, Aniruddh P. Factors affecting outcome in poor grade subarachnoid haemorrhage: An institutional study. Asian J Neurosurg 2016; 11:365-371. [PMID: 27695539 PMCID: PMC4974960 DOI: 10.4103/1793-5482.149991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Context: Poor grade subarachnoid hemorrhage (SAH) is usually associated with unfavorable outcomes and optimal management is deemed complicated. Most centres follow an expectant management strategy or a less aggressive approach till patients improve to good clinical grades. This approach has been associated with higher mortality and morbidity. However, not all patients with poor clinical condition fare badly. Identification and early aggressive management of this select group of patients may lead to favorable outcomes. Settings and Design: Prospective non-randomized study. Materials and Methods: We prospectively analyzed 19 cases presented in WFNS grade 4 and 5 and factors affecting their outcome at a tertiary care centre in south India. This study was aimed at identifying those few poor grade patients who are probable candidates for a good outcome. Statistical Analysis Used: All the variables were analyzed for possible correlations with the SPSS version 13 software. The Chi-square test with a P < 0.05 was taken as statistically significant. Results: Of 19 cases, 13 were operated and good outcome was seen in 53.8% of the patients who underwent surgery and aggressive management. All 7 patients who were managed conservatively died. 15.8% of the patients had low density changes (P = 0.625). Absence of such changes was associated with a good long term outcome (P = 0.004). 9 patients had intraventricular hemorrhage at presentation and 5 patients having hydrocephalus underwent extra-ventricular drainage. Statistically significant factors precluding good outcome were the presence of infarcts and thick SAH in the cisterns. Conclusions: Poor grade (WFNS 4 and 5) SAH patients with or without ICH, IVH, if operated within 3 days can give rise to favorable outcome in around 50%. However, presence of patchy infarcts associated with thick subarachnoid blood (Fisher grade 3) precludes long term survival or meaningful recovery. Hence, aggressive management is unlikely to alter the natural history of such patients.
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Affiliation(s)
- Sannepaneni Kranthi
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Barada P Sahu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Purohit Aniruddh
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
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Luo YC, Shen CS, Mao JL, Liang CY, Zhang Q, He ZJ. Ultra-early versus delayed coil treatment for ruptured poor-grade aneurysm. Neuroradiology 2014; 57:205-10. [DOI: 10.1007/s00234-014-1454-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
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Komotar RJ, Schmidt JM, Starke RM, Claassen J, Wartenberg KE, Lee K, Badjatia N, Connolly ES, Mayer SA. RESUSCITATION AND CRITICAL CARE OF POOR-GRADE SUBARACHNOID HEMORRHAGE. Neurosurgery 2009; 64:397-410; discussion 410-1. [DOI: 10.1227/01.neu.0000338946.42939.c7] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
AS OUTCOMES HAVE improved for patients with aneurysmal subarachnoid hemorrhage, most mortality and morbidity that occur today are the result of severe diffuse brain injury in poor-grade patients. The premise of this review is that aggressive emergency cardiopulmonary and neurological resuscitation, coupled with early aneurysm repair and advanced multimodality monitoring in a specialized neurocritical care unit, offers the best approach for achieving further improvements in subarachnoid hemorrhage outcomes. Emergency care should focus on control of elevated intracranial pressure, optimization of cerebral perfusion and oxygenation, and medical and surgical therapy to prevent rebleeding. In the postoperative period, advanced monitoring techniques such as continuous electroencephalography, brain tissue oxygen monitoring, and microdialysis can detect harmful secondary insults, and may eventually be used as end points for goal-directed therapy, with the aim of creating an optimal physiological environment for the comatose injured brain. As part of this paradigm shift, it is essential that aggressive surgical and medical support be linked to compassionate end-of-life care. As neurosurgeons become confident that comfort care can be implemented in a straightforward fashion after a failed trial of early maximal intervention, the usual justification for withholding treatment (survival with neurological devastation) becomes less relevant, and lives may be saved as more patients recover beyond expectations.
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Affiliation(s)
- Ricardo J. Komotar
- Department of Neurological Surgery, Columbia University, New York, New York (Komotar)
| | - J. Michael Schmidt
- Neurological Intensive Care Unit, Department of Neurology, Columbia University, New York, New York
| | - Robert M. Starke
- Department of Neurological Surgery, Columbia University, New York, New York (Komotar)
| | - Jan Claassen
- Department of Neurological Surgery, Columbia University, New York, New York (Komotar)
- Neurological Intensive Care Unit, Department of Neurology, Columbia University, New York, New York
| | | | - Kiwon Lee
- Department of Neurological Surgery, Columbia University, New York, New York (Komotar)
- Neurological Intensive Care Unit, Department of Neurology, Columbia University, New York, New York
| | - Neeraj Badjatia
- Neurological Intensive Care Unit, Department of Neurology, Columbia University, New York, New York
| | - E. Sander Connolly
- Neurological Intensive Care Unit, Department of Neurological Surgery, Columbia University, New York, New York
| | - Stephan A. Mayer
- Department of Neurological Surgery, Columbia University, New York, New York (Komotar)
- Neurological Intensive Care Unit, Department of Neurology, Columbia University, New York, New York
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Kim SH, Yoon SM, Shim JJ, Bae HG. Coil Embolization of Aneurysm Followed by Stereotactic Aspiration of Hematoma in a Patient with Anterior Communicating Artery Aneurysm Presenting with SAH and ICH. J Korean Neurosurg Soc 2008; 43:41-4. [PMID: 19096545 DOI: 10.3340/jkns.2008.43.1.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 01/02/2008] [Indexed: 11/27/2022] Open
Abstract
Even though intracerebral hematoma (ICH) due to ruptured cerebral aneurysm has been treated by aneurysm clipping at the same time of removal of ICH through craniotomy, such management strategy is controversial in an aged patients with poor clinical grade. In this regards, stereotactic aspiration of hematoma following coil embolization can be an alternative treatment modality. Thus, the authors report a case of an aged patient who underwent stereotactic aspiration of ICH following coil embolization for the ruptured aneurysm with a brief review of literature.
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Affiliation(s)
- Sung-Ho Kim
- Department of Neurosurgery, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
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Pereira AR, Sanchez-Peña P, Biondi A, Sourour N, Boch AL, Colonne C, Lejean L, Abdennour L, Puybasset L. Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage. Neurocrit Care 2007; 7:18-26. [PMID: 17657653 DOI: 10.1007/s12028-007-0053-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe features in patients admitted to the intensive care unit (ICU) for poor-grade aneurysmal subarachnoid hemorrhage (SAH) and to identify predictors of 12-month outcome. METHODS We conducted a controlled observational study of 51 consecutive patients treated with endovascular coiling within 96 h of rupture for poor-grade aneurysmal SAH (20 men and 31 women, age 54 +/- 12 years). We recorded co-morbidities; initial severity; aneurysm location; occurrence of acute hydrocephalus, initial seizures, and/or neurogenic lung edema; troponin values, Fisher grade; computed tomography (CT) findings; treatment intensity; and occurrence of vasospasm. The brain injury marker S100B was assayed daily over the first 8 days. Glasgow Outcome Scores (GOS) were recorded at ICU discharge, at 6 and 12 months. The main outcome criterion was the 1-year GOS score, which we used to classify patients as having a poor outcome (GOS 1-3) or a good outcome (GOS 4-5). RESULTS Overall, clinical status after 1 year was very good (GOS 5) in 41% of patients and good (GOS 4) in 16%. Neither baseline characteristics nor interventions differed significantly between patients with good outcome (GOS 4-5) and those with poor outcome (GOS 1-3). Persistent intracranial pressure elevation and higher mean 8-day S100B value significantly and independently predicted the 1-year GOS outcome (P = 0.008 and P = 0.001, respectively). CONCLUSIONS Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1-3) after 1 year.
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Affiliation(s)
- Ana R Pereira
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie-Paris 6 University, Paris, France
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8
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Mocco J, Ransom ER, Komotar RJ, Sergot PB, Ostapkovich N, Schmidt JM, Kreiter KT, Mayer SA, Connolly ES. Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage. J Neurol 2006; 253:1278-84. [PMID: 17063319 DOI: 10.1007/s00415-006-0179-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 11/30/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND While efforts have been made to document short-term outcomes following poor grade aneurysmal subarachnoid hemorrhage (aSAH), no data exist concerning the degree of delayed improvement in neurological function. Here we assess cognitive function, level of independence, and quality of life (QoL) over 12 months following poor grade aSAH. METHODS Data on definitively treated poor grade patients (Hunt and Hess grade IV or V) surviving 12 months post-aSAH were obtained through a prospectively maintained SAH database. Demographic information, medical history, and clinical course were analyzed. Health outcomes assessments completed by surviving patients at discharge (DC), three months (3 M) and 12 months (12 M) follow-up, including the Telephone Interview for Cognitive Status (TICS), Barthel Index (BI), and Sickness Impact Profile (SIP), were used to evaluate cognitive function, level of independence, and QoL. FINDINGS Fifty-six poor grade patients underwent aneurysm-securing intervention and survived at least 12 months post-aSAH. Thirty-five (63%) surviving patients underwent health outcomes assessments at DC, 3 M and 12 M post-aSAH. A majority of patients had improved scores on the TICS (DC to 3 M: 91%; 3 M to 12 M: 82%), BI (DC to 3 M: 96%; 3 M to 12 M: 92%), and SIP (3 M to 12 M: 80%) following aSAH. Using paired-sample analyses, significant improvement on each test was observed. CONCLUSION A substantial portion of patients experience cognitive recovery, increased independence, and improved QoL following poor grade aSAH. Delayed follow-up assessments are necessary when evaluating functional recovery in this population. These findings have the potential to impact poor grade aSAH management and prognosis.
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Affiliation(s)
- J Mocco
- Department of Neurological Surgery, Columbia University, New York, NY 10032, USA
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Mocco J, Ransom ER, Komotar RJ, Schmidt JM, Sciacca RR, Mayer SA, Connolly ES. Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery 2006; 59:529-38; discussion 529-38. [PMID: 16955034 DOI: 10.1227/01.neu.0000228680.22550.a2] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate which presentation indices, demographics, and clinical information predict 12-month outcome in poor-grade aneurysmal subarachnoid hemorrhage (SAH), and to provide a preoperative index of prognosis. METHODS Data were obtained on all patients with poor-grade (Hunt and Hess Grades IV and V) aneurysmal SAH from a prospectively maintained SAH database and health outcomes project. Demographics, medical history, presenting clinical condition, and health outcomes were analyzed. Survival analysis was performed and Kaplan-Meier curves were generated. Multivariable logistic regression analysis was used to identify significant predictors of poor outcome at 12 months after hemorrhage, as measured by the modified Rankin disability scale. RESULTS Survival curves for open surgery and endovascular treatment did not differ significantly. Overall, 40% of the 98 definitively treated patients had a favorable outcome at 12 months. Multivariable analysis identified patient age older than 65 years (P < 0.001), hyperglycemia (P < 0.03), worst preoperative Hunt and Hess Grade V (P < 0.0001), and aneurysm size of at least 13 mm (P < 0.002) as significant predictors of poor outcome. These variables were weighted and used to compute a poor-grade aneurysmal SAH Prognosis Score (hereafter, Prognosis Score) for each patient. A Prognosis Score of 0 was associated with a 90% favorable outcome; Prognosis Score of 1 with 83%; Prognosis Score of 2 with 43%; Prognosis Score of 3 with 8%; Prognosis Score of 4 with 7%; and a Prognosis Score of 5 with 0%. CONCLUSION Outcome in poor-grade aneurysmal SAH is strongly predicted by patient age, worst preoperative Hunt and Hess clinical grade, and aneurysm size. Hyperglycemia on admission after poor-grade aneurysmal SAH increases the likelihood of poor outcome, and is a potentially modifiable risk factor. The Prognosis Score is a useful tool for preoperatively assessing the likelihood of a favorable outcome for poor-grade aneurysmal SAH patients.
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Affiliation(s)
- J Mocco
- Department of Neurological Surgery, Columbia University, New York, New York 10032, USA
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Proust F, Bonafé A, Lejeune JP, de Kersaint-Gilly A, Gabrillargues J, Dufour H, Puybasset L, Bruder N, Hans P, Beydon L, Audibert G, Boulard G, Ter Minassian A, Berré J, Ravussin P. L'anévrisme : occlure le sac pour prévenir le resaignement. ACTA ACUST UNITED AC 2005; 24:746-55. [PMID: 15922551 DOI: 10.1016/j.annfar.2005.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Proust
- Service de neurochirurgie, hôpital Charles-Nicolle, rue de Germont, 76031 Rouen cedex, France.
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Shin YS, Kim SY, Kim SH, Ahn YH, Yoon SH, Cho KH, Cho KG. One-stage embolization in patients with acutely ruptured poor-grade aneurysm. ACTA ACUST UNITED AC 2005; 63:149-54; discussion 154-5. [PMID: 15680657 DOI: 10.1016/j.surneu.2004.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 03/22/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early or ultra-early surgery for patients in poor neurological condition (Hunt and Hess grade IV or V) after ictus of aneurysmal subarachnoid hemorrhage is increasingly reported to prevent early rebleeding. To prevent any rebleeding after hospital admission, we have treated patients with poor-grade aneurysm during the same session as when diagnostic angiography is performed ("one-stage embolization"). The aim of the present study is to determine whether this treatment modality is a viable management option for this group of patients. METHODS We retrospectively reviewed 18 consecutive patients who presented with acutely ruptured aneurysms and were in very poor neurological condition and who were treated with one-stage embolization. RESULTS We observed 2 complications related to the endovascular procedure: partial occlusion of the parent artery and aneurysm rupture during the procedure. According to the Glasgow Outcome Scale, good recovery occurred in 8 patients, and moderate and severe disabilities occurred in 4 and 3 patients, respectively, and 3 patients died. No rebleeding occurred after the procedure. The mean follow-up of the surviving patients (those who were alive more than 30 days after embolization) was 13.7 months (4-25 months). Three patients had surgery after endovascular procedure: 2 surgical clipping of failed or partial aneurysm embolization and 1 emergency coil removal with clipping. A permanent ventriculoperitoneal shunt was placed in 11 patients. CONCLUSIONS We achieved promising results by using one-stage embolization to prevent ultra-early rebleeding followed by aggressive resuscitation. The active involvement of the endovascular team from the stage of diagnostic angiogram is a prerequisite for this treatment strategy.
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Affiliation(s)
- Yong Sam Shin
- Department of Neurosurgery, School of Medicine, Ajou University, Suwon, Republic of Korea.
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Sturaitis MK, Rinne J, Chaloupka JC, Kaynar M, Lin Z, Awad IA. Impact of Guglielmi detachable coils on outcomes of patients with intracranial aneurysms treated by a multidisciplinary team at a single institution. J Neurosurg 2000; 93:569-80. [PMID: 11014534 DOI: 10.3171/jns.2000.93.4.0569] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECT The goal of this study was to investigate the impact of the introduction of the Guglielmi detachable coil (GDC) therapeutic option on the overall management outcome of intracranial aneurysms. The authors accomplished this by assessing patient morbidity and mortality, inflation-adjusted hospital charges, lengths of stay in the hospital and the intensive care unit (ICU), and treatment efficacy. METHODS The authors conducted a retrospective analysis of consecutive cases of intracranial intradural aneurysms managed by a single multidisciplinary neurovascular team at a tertiary care, academic referral center during the 24 months preceding the introduction of the GDC procedure (Group I or pre-GDC era, 77 patients) and during the first 24 months after its introduction (Group II or GDC era, 99 patients). Treatment with GDCs was considered for cases of higher clinical grade or poor surgical risk, or in response to patient preference (27 [27%] of 99 patients in Group II). Host and lesion parameters in our cohort were validated against outcome parameters by using univariate and multivariate analyses. The pre-GDC and GDC subgroups of patients were comparable for major disease severity parameters (patient age, lesion location, clinical grade, and hemorrhage severity). There was no significant difference in clinical outcome at 6 months, infarcts on computerized tomography scanning, or aneurysm obliteration rates before and after introduction of GDC treatment. Decreasing trends in duration of hospital and ICU stay and in inflation-adjusted hospital charges occurred well before and thus were unrelated to the introduction of the GDC therapeutic option. CONCLUSIONS The results of this study do not demonstrate any significant impact of integration of the GDC modality on clinical outcome, mortality, morbidity, or effectiveness of treatment. Ongoing improvements in hospital charges and length of hospital stay appeared unrelated to the introduction of the GDC option.
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Affiliation(s)
- M K Sturaitis
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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