Ultra-Early (within 24 Hours) Aneurysm Treatment After Subarachnoid Hemorrhage
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作者:
Wong, George Kwok Chu
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Chinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R ChinaChinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
Wong, George Kwok Chu
[1
]
Boet, Ronald
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St George Hosp, Christchurch, New ZealandChinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
Boet, Ronald
[3
]
Ng, Stephanie Chi Ping
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Chinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R ChinaChinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
Ng, Stephanie Chi Ping
[1
]
Chan, Matthew
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Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R ChinaChinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
Chan, Matthew
[2
]
Gin, Tony
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Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R ChinaChinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
Gin, Tony
[2
]
Zee, Benny
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机构:Chinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
Zee, Benny
Poon, Wai Sang
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Chinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R ChinaChinese Univ Hong Kong, Div Neurosurg, Hong Kong, Hong Kong, Peoples R China
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
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.