The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3

Inamasu, Joji; Nakae, Shunsuke; Ohmi, Tatsuo; Kogame, Hirotaka; Kawazoe, Yushi; Kumai, Tadashi; Tanaka, Riki; Wakako, Akira; Kuwahara, Kiyonori; Ganaha, Tsukasa; Hirose, Yuichi

doi:10.1016/j.jocn.2016.03.035

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Active treatment, in particular aneurysm repair, increases the chance of survival in aSAH patients [6,51]. Vice versa, the chances to survive are poorer with conservative management, and will in grade V patients almost throughout result in death within hours or few days [16,19,23,26,33,59]. Also in the present study, all conservatively managed patients died.…”

Section: Survivalsupporting

confidence: 51%

“…Mortality in the subgroup of those actively treated including aneurysm repair is lower with 32-57%: one year survival in those that underwent aneurysm repair (53%, n=78/146) was presently lower than that reported by Wostrack et al [59] at 3 months in WFNS grade V patients (67%, n=69/103) and Konczalla et al [19] at 6 months in Hunt and Hess grade V patients (68%, n=94/139), but similar to that of Laidlaw and Siu [23] at 3 months in WFNS V patients (50%, n=50/99) and Inamasu et al [16] at 3 months in GCS 3 patients (57%, n=29/51). Le Roux et al [26] on the other hand, reported a somewhat lower survival at months in their Hunt and Hess grade V patients (42%, n=33/78), as did Mocco et al [33] at 1 year (43%, n=23/53).…”

Section: Survivalmentioning

confidence: 56%

“…When investigating outcome in terms of cognitive functioning and health-related quality of life one year after the ictus, Haug et al [11] found that more than half of Hunt and Hess grade V survivors had good cognitive and physical function, at a quality of life not significantly different from the population mean. Their findings were later confirmed by several larger studies on comatose aSAH patients that also were managed rigorously with early intervention [16,19,59]. Despite many patients recovering to a good functional outcome after aSAH, many have permanent residual symptoms impairing their daily live and ability to return to work [10].…”

Section: Functional Outcomementioning

confidence: 79%

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Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

et al. 2020

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Background: Outcome of early, aggressive management of aneurysmal subarachnoid hemorrhage (aSAH) in patients with Hunt and Hess grade V is hitherto limited and we therefore present our results. Methods: Retrospective study analyzing the medical data of 228 aSAH patients in Glasgow Coma Score 3-5 admitted at our hospital during the years 2002-2012. Background and treatment variables were registered. Outcome was evaluated after three and twelve months. Results: We intended to treat 176 (77.2%) patients, but only 146 went on to aneurysm repair. Of 52 patients managed conservatively, 27 had abolished cerebral circulation around arrival and 25 were deemed unsalvageable. One-year overall mortality was 65.8% and most (84.7%) of the fatalities occurred within 30 days. One-year mortality was higher in patients >70 years. Without aneurysm repair, mortality was 100%. After one year, 21.9% of all patients lived independently and 4.8% lived permanently in an institution. Outcome in the 78 survivors (34.2%) was favorable in 64.1% in terms of modified Rankin Scale score 0-2 and 85.9% of survivors were able to live at home. Return to work was low for all 228 patients with 14.0% of those employed prior to the hemorrhage having returned to paid work, and respectively, 26.3% in the subgroup of survivors. Conclusions: Even with aggressive, early treatment, one-year mortality is high in comatose aSAH patients with 65.8%. A substantial portion of the survivors have a favorable outcome at one year (64.1%, corresponding to 21.9% of all patients admitted) and 85.9% of the survivors could live at home alone or aided.

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Section: Survivalsupporting

confidence: 51%

Section: Survivalmentioning

confidence: 56%

Section: Functional Outcomementioning

confidence: 79%

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Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

et al. 2020

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“…A total of 53 patients (57.6%) received endovascular treatment with LVIS stent and 39 (42.4%) received endovascular treatment with non-LVIS stent (Table I). The major exclusion criteria were as follows: A World Federation of Neurosurgical Societies grade 5 (16), massive cerebral infarction (>50% of the MCA aneurysms) demonstrable on computed tomography (CT) examination, and patients with a history of tumor, migraine, cerebral hemorrhage or brain surgery injury. The major inclusion criteria were as follows: Digital subtraction angiography imaging studies demonstrating occlusion of a unilateral internal carotid artery or MCA and a modified Rankin Scale (mRS) score of 0–2 (17).…”

Section: Methodsmentioning

confidence: 99%

Endovascular treatment of middle cerebral artery aneurysm with a (LVIS) device: Comparison of LVIS stent and non‑LVIS stent

Chen

Fang

2018

Exp Ther Med

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Middle cerebral artery (MCA) aneurysm is a serious medical condition mainly occurring in the proximal and bifurcation tracts. Evidence has indicated that endovascular treatment is an effective surgical method for patients with MCA aneurysm. In the present study, the efficacy of endovascular treatment with low-profile visualized intraluminal support (LVIS) stent for MCA aneurysms was evaluated in comparison with that using a non-LVIS stent device. A total of 92 patients who underwent endovascular treatment of MCA aneurysms with LVIS stent or non-LVIS stent were included in the present study. The clinical presentation, aneurysmal characteristics, technical feasibility, procedural complications, as well as angiographic and clinical follow-up results were analyzed. The computed tomography scan demonstrated that endovascular treatment with LVIS stent markedly reduced pre-operative and intra-operative ruptures. It was indicated that endovascular treatment with LVIS stent resulted in less post-operative symptoms and cases of disability according to the modified Rankin scale score. In conclusion, the present outcomes provide evidence that endovascular treatment with an LVIS stent is an efficient method for the treatment of MCA aneurysm.

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“…We included six studies in the systematic review investigating the effect of sex on functional outcome. Five studies ( n = 427) were eligible for meta-analysis [ 15 , 23 , 26 , 32 , 35 ]. We did not observe an association between sex and the likelihood of favorable functional outcome (pooled aOR 0.5, 95% CI 0.1–1.4, Fig.…”

Section: Resultsmentioning

confidence: 99%

Early predictors of functional outcome in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

et al. 2022

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Background Patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) often receive delayed or no aneurysm treatment, although recent studies suggest that functional outcome following early aneurysm treatment has improved. We aimed to systematically review and meta-analyze early predictors of functional outcome in poor-grade aSAH patients. Methods We included studies investigating the association of early predictors and functional outcome in adult patients with confirmed poor-grade aSAH, defined as World Federation of Neurological Surgeons (WFNS) grade or Hunt and Hess (H–H) grade IV-V. Studies had to use multivariable regression analysis to estimate independent predictor effects of favorable functional outcome measured with the Glasgow Outcome Scale or modified Rankin Scale. We calculated pooled adjusted odds ratios (aOR) and 95% confidence intervals (CI) with random effects models. Results We included 27 studies with 3287 patients. The likelihood of favorable outcome increased with WFNS grade or H–H grade IV versus V (aOR 2.9, 95% CI 1.9–4.3), presence of clinical improvement before aneurysm treatment (aOR 3.3, 95% CI 2.0–5.3), and intact pupillary light reflex (aOR 2.9, 95% CI 1.6–5.1), and decreased with older age (aOR 0.7, 95% CI 0.5–1.0, per decade), increasing modified Fisher grade (aOR 0.4, 95% CI 0.3–0.5, per grade), and presence of intracerebral hematoma on admission imaging (aOR 0.4, 95% CI 0.2–0.8). Conclusions We present a summary of early predictors of functional outcome in poor-grade aSAH patients that can help to discriminate between patients with favorable and with unfavorable prognosis and may aid in selecting patients for early aneurysm treatment.

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The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3

Cited by 10 publications

References 25 publications

Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

Endovascular treatment of middle cerebral artery aneurysm with a (LVIS) device: Comparison of LVIS stent and non‑LVIS stent

Early predictors of functional outcome in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

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