Timing and outcome of bystanders treatment in patients with subarachnoid hemorrhage associated with multiple aneurysms

Abstract

In case of subarachnoid hemorrhage (SAH) associated with multiple intracranial aneurysms (MIAs), the main goal of acute treatment is securing the source of bleeding (index aneurysm). Indications and timing of bystanders treatment are instead still debated as the risk of new SAHs in patients harboring MIAs is not yet established. However, even if technically feasible, a simultaneous management of all aneurysms remains questionable, especially for safety issues. We retrospectively reviewed our last 5-year experience with SAH patients harboring MIAs entered in a clinic-radiological monitoring for bystanders follow-up in order to evaluate the occurrence of morphological changes, bleeding events, and safety and efficacy of a delayed treatment. We included 39 patients with mean age of 59.5 ± 12.2 years who survived a SAH. Among them, 14 underwent treatment, whereas 25 continued follow-up. The mean time between index and bystanders treatment was 14.3 ± 19.2 months. Patients undergoing bystanders treatment were mainly female and in general younger than patients undergoing observation. No cases of growth or bleeding were observed among bystanders within the two groups during the follow-up, which was longer than 1 year for the intervention group, and almost 40 months for the observation group. No major complications and mRS modifications were observed after bystanders treatment. Our data seem to suggest that within the short follow-up, intervention and observation seem to be likewise safe for bystander aneurysms, showing at the same time that a delayed management presents a similar risk profile of treating unruptured aneurysms in patients with no previous history of SAH.

Application of zone classification in multiple intracranial aneurysmal subarachnoid hemorrhage treatment strategies

“…A long-term follow-up study [ 18 ] revealed that patients with moderate or severe disability after SAH have a relatively low risk of UIA rupture. Furthermore, over shorter follow-up, intervention and observation appear similarly safe for bystander aneurysms in MIAs [ 19 ].…”

Frequency and Characteristics of Paraclinoid Aneurysm in Ruptured Cerebral Aneurysms

“…Among the seven patients with paraclinoid aneurysms, five patients (71%; one ruptured and four unruptured aneurysms) showed multiple aneurysms, in which a frequency of multiple aneurysms was higher than a frequency in our study 8) . Regarding multiple aneurysms in entire intracranial locations, Sturiale et al 16) reported that associated other location aneurysms were found in 62 of 265 patients (23%) with ruptured cerebral aneurysms. Ruptured paraclinoid aneurysms may be more frequently associated with other cerebral aneurysms than aneurysms in other locations.…”

Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms

“…While new definitions and classifications of aneurysm complexity have emerged [ 1 , 3 , 5 ], they often lack a quantitative assessment of the combined qualitative features and their relevance for treatment. This correlation between complexity features and treatment is increasingly crucial in a multidisciplinary context, especially for middle cerebral artery (MCA) aneurysms, which are the most frequently surgically treated [ 9 , 10 , 11 , 12 , 13 , 14 ]. The correct identification of complexity features in MCA aneurysms is fundamental in preoperatively identifying the possible pitfalls during the treatment.…”