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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.
Glossary
- aSAH=
- aneurysmal subarachnoid hemorrhage;
- BRAT=
- Barrow Ruptured Aneurysm Trial;
- CI=
- confidence interval;
- DCI=
- delayed cerebral ischemia;
- ICU=
- intensive care unit;
- OR=
- odds ratio;
- ISAT=
- International Subarachnoid Aneurysm Trial;
- mRS=
- modified Rankin Scale;
- NNT=
- number needed to treat;
- SAH=
- subarachnoid hemorrhage
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Patient page e1915
- Received October 6, 2019.
- Accepted in final form June 8, 2020.
- © 2020 American Academy of Neurology
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