Suboptimal interventional conditions for the occlusion of ruptured intracranial aneurysms do not increase periprocedural complications and poor clinical outcomes

• Published in: Acta neurochirurgica Vol. 156; no. 7; pp. 1267 - 1272
• Main Authors: Matías-Guiu, J. A., Avecillas-Chasín, J., Barcia, J. A, Moreu, M., López-Ibor, L.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.07.2014; Springer Nature B.V
• Subjects: Adult; Aged; Aneurysm, Ruptured - surgery; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Experimental Research -Vascular; Female; Humans; Hydrocephalus - epidemiology; Incidence; Interventional Radiology; Intracranial Aneurysm - surgery; Intraoperative Complications - epidemiology; Male; Medical Staff, Hospital; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Multivariate Analysis; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Personnel Staffing and Scheduling; Regression Analysis; Retrospective Studies; Surgical Orthopedics; Time Factors; Treatment Outcome; Vasospasm, Intracranial - epidemiology; Rebleeding; Subarachnoid haemorrhage; Aneurysm; Coil
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-014-2106-9

Background and objective Occluding a ruptured intracranial aneurysm as early as possible may entail certain periprocedural conditions that compromise the outcome. The aim of the present study was to evaluate the effectiveness, safety, and clinical outcome of endovascular coiling procedures performed on an emergency basis under potentially suboptimal conditions, and to compare results with those from scheduled procedures under potentially optimal conditions. Methods Interventions performed on 66 SAH patients were retrospectively analysed by classifying them into two groups: under emergency (within three hours from diagnosis or during non–standard working hours) or scheduled conditions. A binary logistic regression analysis was also performed to identify characteristics associated with poor outcomes. Results No differences in effectiveness, periprocedural complications, or clinical outcomes were found between the two groups. Rebleeding was detected in 4.8 % of the emergency interventions and 2.2 % of the scheduled interventions. Multivariate analysis identified age and Hunt and Hess grade, but no conditions of treatment, as the factors associated to poor outcome. Conclusion Suboptimal interventional conditions for occluding ruptured intracranial aneurysms, such as performing procedures outside of standard working hours or within three hours of diagnosis, do not result in increased periprocedural complications and poor clinical outcomes compared with scheduled procedures under potentially optimal conditions. These results suggest the need for treatment to be provided as soon as possible.