Ultra-Early (within 24 Hours) Aneurysm Treatment After Subarachnoid Hemorrhage

被引:100
作者
Wong, George Kwok Chu [1 ]
Boet, Ronald [3 ]
Ng, Stephanie Chi Ping [1 ]
Chan, Matthew [2 ]
Gin, Tony [2 ]
Zee, Benny
Poon, Wai Sang [1 ]
机构
[1] Chinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
[2] Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R China
[3] St George Hosp, Christchurch, New Zealand
关键词
Aneurysm; Clipping; Embolization; Subarachnoid hemorrhage; Timing; RUPTURED INTRACRANIAL ANEURYSMS; INTRAVENOUS MAGNESIUM-SULFATE; GLASGOW OUTCOME SCALE; EARLY SURGERY; CEREBRAL INFARCTION; PROGNOSTIC-FACTORS; GRADE; VASOSPASM; IMPACT; TRIAL;
D O I
10.1016/j.wneu.2011.09.025
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: The timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage was a subject of controversy. Although most vascular neurosurgeons agreed on early aneurysm treatment (within the first 72 hours), whether ultra-early aneurysm treatment (within the first 24 hours) was beneficial remained debatable. We aimed to investigate whether ultra-early aneurysm treatment is associated with better neurological outcome in all patients or only good-grade patients or only poor-grade patients. METHODS: Two-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. Values of P < 0.05 were taken as statistically significant, and P values between 0.05 and 0.10 were considered to be a trend. RESULTS: For the 96 poor-grade (World Federation of Neurological Surgeons grading scale 4 to 5) patients, there was a significant association between Short Form-36 mental scores and ultra-early aneurysm treatment (50 +/- 10 vs. 46 +/- 10, P = 0.019) and a trend toward association between ultra-early surgery and favorable neurological outcome (odds ratio 2.4 [95% confidence interval 1.0 to 6.0], P = 0.062). A reduction in clinical rebleeding (12% vs. 22%, P = 0.168) was observed in patients undergoing ultra-early aneurysm treatment. CONCLUSIONS: Aneurysm treatment performed within the 24-hour window may be associated with a better outcome and halve the clinical rebleeding risk in poor-grade aneurysmal subarachnoid hemorrhage patients.
引用
收藏
页码:311 / 315
页数:5
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