Predictive factors for pre-intervention rebleeding in aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

Emerging anesthesia techniques for managing intraoperative rupture of cerebral aneurysms

“…There is a close relationship between changes in systemic pressures and corresponding changes in arterial pressures within an aneurysm sac and its parent artery 16 . Furthermore, evidence shows that patients with SAH who have elevated blood pressure, particularly a systolic blood pressure (sBP) >160 mm Hg, during admission are at risk of aneurysm rebleeding 17 . Therefore, in keeping with general anesthesia recommendations for the management of cerebral aneurysms, 18 it is prudent to avoid sudden episodes of hypertension to reduce the risk of IAR.…”

Pre-treatment re-bleeding following aneurysmal subarachnoid hemorrhage: a systematic review of prediction models

“…[2,7,8] Treatment within 24 hours of rupture termed ultra-early treatment has been associated with reduced mortality and a reduced likelihood of a poor neurological outcome[8] however a meta-analysis [9] and a recent large propensity-matched study [10] have cast doubt on whether treatment timing alone is associated with a bene t. This ambiguity together with the increased cost and logistical burden [11][12][13] has placed a renewed emphasis on accurate re-bleed prediction. Location, [7,14] size, [1,2,7,[14][15][16][17] morphology, [16,18,19] clinical grade, [7,15,16,20,21] radiological grade, [2,6,16,21] hypertension, [7,14,16,18] systolic blood pressure over 160mmHg, [21] hydrocephalus, [2,6,14] pre-treatment external ventricular drain (EVD) insertion, [13] intracerebral haematoma (ICH) [14] and intraventricular hemorrhage (IVH) at diagnosis [7] have been associated with pre-treatment re-bleeding. A number of clinical prediction models have been recently described incorporating these and other time-independent factors.…”

In Reply: Clinical Impact and Predictors of Aneurysmal Rebleeding in Poor-Grade Subarachnoid Hemorrhage: Results From the National POGASH Registry

“…Nonetheless, the role of premorbid treated hypertension, rather than being “novel, unprecedented, and biologically implausible,” has been evaluated before. 4,5 It further testify the need for a scrupulous evaluation and adequate management of blood pressure in the emergency, pretreatment phase in this population, and the potential protective effects of antihypertensive medications on aneurysmal rebleeding.…”

“…This could be applied, for example, randomizing ruptured dissecting aneurysm amenable to endovascular occlusion, to an immediate treatment, regardless of admission hour, as compared with the standard routine practice in many centers where endovascular treatment is not performed during nighttime because of supposed negligible effect on rebleeding rates and high costs. 4 Regarding the distinction between pretreatment vs posttreatment rebleeding, a thorough analysis in the poor-grade setting cannot exclude post-treatment rebleeding (9/443 patients, 2%), which were almost equally distributed between endovascular (5 cases) and surgical (4 cases) treatment.…”