Artikel
Treatment results of patients with aneurysmal subarachnoid hemorrhage: outcome and prognostic factors in a large contemporary series
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Veröffentlicht: | 4. Juni 2012 |
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Objective: To report the management and outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) in a large contemporary series.
Methods: From 1999 to 2010, 1797 patients admitted with subarachnoid hemorrhage in our institution. Patient and aneurysm specific characteristics as well as treatment and SAH related complications were entered into our prospectively conducted database. Treatment decision was based on an interdisciplinary approach. Outcome was assessed according to modified Rankin scale (mRs) at 6 months (0–2 favourable vs. 3–6 unfavourable).
Results: Treatment was performed endovascular in 56% and surgical in 44% of the patients with aneurysmal SAH. 37% of the patients who underwent clipping versus 33% who underwent endovascular treatment were in poor grade (H&H 4–5) at admission. Treatment related complications included ischemic brain infarction, thrombembolic events, and bleeding, and was 8.8% for surgery, and 9.3% for endovascular treatment. Overall favourable outcome was achieved in 72.4% of patients treated surgically versus 76.3% treated endovascularly. In the multivariate analysis, poor grade at admission (p < 0.0001, OR 4.6, 95% CI 3.0–7.2), age > 65 years (p < 0.0001, OR 4.1, 95% CI 2.4–6.9), additional intracerebral hematoma (p = 0.001, OR 2.3, 95% CI 1.4–3.8), and hydrocephalus at admission (p < 0.0001, OR 2.9, 95% CI 1.8–4.9) were predictors for poor outcome after 6 months.
Conclusions: Despite of a high rate of poor grade patients at admission, a significant number of patients achieve favourable outcome in an interdisciplinary setting.