Abstract WP82: Effect Of Ultra-early Endovascular Intracranial Aneurysm Treatment On Rebleeding And Outcomes In Patients With Subarachnoid Hemorrhage
Background: The American Heart Association (AHA) recommends early aneurysm treatment without specifying any specific time intervals in patients with subarachnoid hemorrhage [SAH] [Bederson JB, et al.Stroke. 2009;40:994-1025].The AHA further requires documentation of proportion of SAH patients treated within 36 hours after admission as a Quality of Care metrics in Comprehensive Stroke Centers. [Leifer D, et al. Stroke. 2011; 42: 849-877]However, the definition of early treatment remains controversial.
Objective: To determine the rates of outcomes associated with ultra-early (<12 hours) and delayed (≥12 hours) intracranial aneurysm treatment after admission in patients with SAH.
Methods: We analyzed the data from 144 consecutive SAH patients from two academic centers who underwent endovascular treatment of ruptured intracranial aneurysms over a period of 4 years. Pre procedure rebleeding was defined by an acute neurological deterioration associated with new hemorrhage apparent on a computed tomographic (CT) scan or an increase in hemorrhage burden on a repeat CT scan. Favorable outcome was defined as modified Rankin score of ≤2 at discharge. Baseline characteristics and outcomes were compared between ultra-early (<12 hours) and delayed (≥12 hours) treatment using univariate analysis and by multivariate analysis after adjustment for confounders.
Results: Of the 144 SAH patients (mean age 54±SD: 13). Ninety nine ( 68% ) were women who underwent endovascular intracranial aneurysm treatment, (58%) underwent ultra-early aneurysm treatment. After adjusting for age, Hunt and Hess and Fisher grades, there was no significant difference in rates of favorable outcomes (odd ratio [OR] 0.6, 95% confidence interval [CI](0.2-1.3) or in-hospital mortality (OR 0.8, 95% CI (0.3-2.3) between the two groups. Pre procedure rebleeding was less likely to occur in the ultra-early treatment group (OR 0.1; 95% CI 0.02-0.4, p<0.002).
Conclusions: Ultra-early aneurysm treatment is possible due to the availability of endovascular treatment and appears to significantly reduce the pre-procedural rebleeding rates in patients with SAH.
- © 2012 by American Heart Association, Inc.