Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage. (29th September 2020)

• Record Type: Journal Article
• Authors: Roquer, Jaume; Cuadrado-Godia, Elisa; Guimaraens, Leopoldo; Conesa, Gerardo; Rodríguez-Campello, Ana; Capellades, Jaume; García-Arnillas, María P.; Fernández-Candil, Juan L.; Avellaneda-Gómez, Carla; Giralt-Steinhauer, Eva; Jiménez-Conde, Jordi; Soriano-Tárraga, Carolina; Villalba-Martínez, Gloria; Vivanco-Hidalgo, Rosa M.; Vivas, Elio; Ois, Angel
• Is Part Of: Neurology. Volume 95:Number 13(2020)
• Publication Date: 2020-09-29
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000010618
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment. Methods: In this prospective observational study, mortality and poor outcome (modified Rankin Scale score 3–6) were analyzed in 311 patients with aSAH at 3 months, 1 year, and 5 years follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed. Results: Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months (odds ratio [OR] 0.36 [95% confidence interval [CI] 0.18-0.74]), with an absolute difference of 15.8% (number needed to treat = 6.3), and at 1 year (OR = 0.40 [95% CI 0.20-0.81]), with an absolute difference of 15.9% (number needed to treat = 6.3). Complications did not differ between the 2 procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR 0.67 [95% CI 0.54–0.84]). Conclusions: Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.