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Observational Study
. 2020 Sep 29;95(13):e1819-e1829.
doi: 10.1212/WNL.0000000000010618. Epub 2020 Aug 13.

Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage

Jaume Roquer  1 , Elisa Cuadrado-Godia  2 , Leopoldo Guimaraens  2 , Gerardo Conesa  2 , Ana Rodríguez-Campello  2 , Jaume Capellades  2 , María P García-Arnillas  2 , Juan L Fernández-Candil  2 , Carla Avellaneda-Gómez  2 , Eva Giralt-Steinhauer  2 , Jordi Jiménez-Conde  2 , Carolina Soriano-Tárraga  2 , Gloria Villalba-Martínez  2 , Rosa M Vivanco-Hidalgo  2 , Elio Vivas  2 , Angel Ois  2
Affiliations
Observational Study

Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage

Jaume Roquer et al. Neurology. .

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.

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Figures

Figure 1
Figure 1. Patient flowchart
*In 4 cases, delayed treatment occurred (flow diverter) beyond the acute phase. SAH = subarachnoid hemorrhage.
Figure 2
Figure 2. Kaplan-Meier survival curves for all treated cases according to treatment modality (p = 0.187)
SAH = subarachnoid hemorrhage.
Figure 3
Figure 3. Kaplan-Meier curves of disability-free outcome for all treated cases according to treatment modality (p = 0.260)
SAH = subarachnoid hemorrhage.
See this image and copyright information in PMC

Comment in

  • Neurology. 95(13):e1915.

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