Abstract
Introduction
Knowledge of risk factors for rebleeding after aneurysmal subarachnoid
haemorrhage can help tailoring ultra-early aneurysm treatment. Previous
studies have identified aneurysm size and various patient-related risk
factors for early (≤24 h) rebleeding, but it remains unknown if aneurysm
configuration is also a risk factor. We investigated whether irregular
shape, aspect- and bottleneck ratio of the aneurysm are independent risk
factors for early rebleeding after aneurysmal subarachnoid haemorrhage.
Patients and methods
From a prospectively collected institutional database, we investigated data
from consecutive aneurysmal subarachnoid haemorrhage patients who were
admitted ≤24 h after onset between December 2009 and January 2015. The
admission computed tomographic angiogram was used to assess aneurysm size
and configuration. With Cox regression, we calculated stepwise-adjusted
hazard ratios (HRs) with 95% confidence intervals (CIs) for irregular shape,
aspect ratio ≥1.6 mm and bottleneck ratio ≥1.6 mm.
Results
Of 409 included patients, 34 (8%) patients had in-hospital rebleeding ≤24 h
after ictus. Irregular shape was an independent risk factor for rebleeding
(HR: 3.9, 95% CI: 1.3–11.3) after adjustment for age, sex, PAASH score,
aneurysm location, aneurysm size and aspect- and bottleneck ratio. Aspect
ratio ≥1.6 mm (HR: 2.3, 95% CI: 0.8–6.5) and bottleneck ratio ≥1.6 mm (HR:
1.7, 95% CI: 0.8–3.6) were associated with an increased risk of rebleeding,
but were not independent risk factors after multivariable adjustment.
Conclusions
Irregular shape is an independent risk factor for early rebleeding. However,
since the majority of subarachnoid haemorrhage patients have an irregular
aneurysm, additional risk factors have to be found for aneurysm treatment
prioritisation.
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