This Article Full Text Full Text (PDF) All Versions of this Article: 36/11/2394    most recent 01.STR.0000185686.28035.d2v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wermer, M. J.H. Articles by Rinkel, G. J.E. Search for Related Content PubMed PubMed Citation Articles by Wermer, M. J.H. Articles by Rinkel, G. J.E. Related Collections Aneurysm, AVM, hematoma

(Stroke. 2005;36:2394.)
© 2005 American Heart Association, Inc.

Original Contributions

Incidence of Recurrent Subarachnoid Hemorrhage After Clipping for Ruptured Intracranial Aneurysms

From the Departments of Neurology and Neurosurgery (M.J.H.W., P.G., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands.

Correspondence to Marieke J.H. Wermer, MD, Department of Neurology: G03.228, University Medical Center Utrecht, Heidelberglaan 100, 3484 CX Utrecht, The Netherlands. E-mail m.wermer{at}neuro.azu.nl

Background and Purpose— Because intracranial aneurysms develop during life, patients with subarachnoid hemorrhage (SAH) and successfully occluded aneurysms are at risk for a recurrence. We studied the incidence of and risk factors for recurrent SAH in patients who regained independence after SAH and in whom all aneurysms were occluded by means of clipping.

Methods— From a cohort of patients with SAH admitted between 1985 and 2001, we included those patients who were discharged home or to a rehabilitation facility. We interviewed these patients about new episodes of SAH. We retrieved all medical records and radiographs in case of reported recurrences. If patients had died, we retrieved the cause of death. We analyzed the incidence of and risk factors for recurrent SAH by Kaplan-Meier curves and Cox regression analysis.

Results— Of 752 patients with 6016 follow-up years (mean follow up 8.0 years), 18 had a recurrence. In the first 10 years after the initial SAH, the cumulative incidence of recurrent SAH was 3.2% (95% confidence interval [CI], 1.5% to 4.9%) and the incidence rate 286 of 100 000 patient-years (95% CI, 160 to 472 per 100 000). Risk factors were smoking (hazard ratio [HR], 6.5; 95% CI, 1.7 to 24.0), age (HR, 0.5 per 10 years; 95% CI, 0.3 to 0.8) and multiple aneurysms at the time of the initial SAH (HR, 5.5; 95% CI, 2.2 to 14.1).

Conclusions— After SAH, the incidence of a recurrence within the first 10 years is 22 (12 to 38) times higher than expected in populations with comparable age and sex. Whether this increased risk justifies screening for recurrent aneurysms in patients with a history of SAH requires further study.

Key Words: cerebral aneurysm • epidemiology • subarachnoid hemorrhage

This article has been cited by other articles:

				D. C. Spencer The state of the art of medicine: Deciding on preventive screening tests after bleeding in the brain Neurology, May 27, 2008; 70(22): e92 - e94. [Full Text] [PDF]

				M. J.H. Wermer, H. Koffijberg, I. C. van der Schaaf, and For the ASTRA Study Group Effectiveness and costs of screening for aneurysms every 5 years after subarachnoid hemorrhage Neurology, May 27, 2008; 70(22): 2053 - 2062. [Abstract] [Full Text] [PDF]

				P. Greebe and G. J.E. Rinkel Life Expectancy After Perimesencephalic Subarachnoid Hemorrhage Stroke, April 1, 2007; 38(4): 1222 - 1224. [Abstract] [Full Text] [PDF]

				A.N. de Gast, M.E. Sprengers, W.J. van Rooij, C. Lavini, M. Sluzewski, and C.B. Majoie Long-Term 3T MR Angiography Follow-Up after Therapeutic Occlusion of the Internal Carotid Artery to Detect Possible de Novo Aneurysm Formation AJNR Am. J. Neuroradiol., March 1, 2007; 28(3): 508 - 510. [Abstract] [Full Text] [PDF]