Determinants of Poor Outcome After Aneurysmal Subarachnoid Hemorrhage when both Clipping and Coiling Are Available: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan

• Published in: World neurosurgery Vol. 76; no. 5; pp. 437 - 445
• Main Author: GROUP, Presat
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier
• Subjects: Aged; Biological and medical sciences; Cerebral aneurysm; Endovascular treatment; Female; Humans; Japan - epidemiology; Male; Medical sciences; Microsurgery; Middle Aged; Neurosurgery; Outcome; Outcome Assessment (Health Care) - methods; Prospective Studies; Registries; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Asia; Japan; A; Cerebral aneurysm; PRESAT; World Federation of Neurosurgical Societies; Middle cerebral artery; Neck size; Cerebrospinal fluid; N; Computed tomography; Modified Rankin Scale; CSF; Prospective Registry of Subarachnoid Aneurysms Treatment; Microsurgery; Endovascular treatment; International Subarachnoid Aneurysm Trial; Subarachnoid hemorrhage; ICA; MCA; mRS; Aneurysmal diameter; CT; Outcome; Internal carotid artery; SAH; WFNS; ISAT; Nervous system diseases; Prognosis; Cardiovascular disease; Endovascular route; Cerebral disorder; Vascular disease; Clip; Treatment; intracranial aneurysm; Surgery; Central nervous system disease; Subarachnoid; Cerebrovascular disease
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2011.04.026

Objective To examine current determinants of poor outcome after aneurysmal subarachnoid hemorrhage (SAH) when ruptured aneurysms are treated with either microsurgery (clipping) or endovascular treatment (coiling) depending on each patient's characteristics. Methods Between March 2006 and February 2007, 534 patients with SAH were enrolled in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) project. Patients were treated according to the preference of investigators who were experienced in performing both clipping and coiling. Factors influencing poor outcome (12-month modified Rankin Scale [mRS], 3–6) were determined using multivariate logistic regression analyses. Results In this cohort, 32.4% of patients were World Federation of Neurosurgical Societies (WFNS) grade IV–V, and 28.1% had a poor outcome. Clipping was preferably performed for small aneurysms with a wide neck and for middle cerebral artery (MCA) aneurysms, whereas coiling was preferred for larger, internal carotid artery (ICA) and posterior circulation aneurysms. In addition to increasing age, admission WFNS grade IV–V, preadmission aneurysmal rerupture, vasospasm-induced cerebral infarct, pneumonia, sepsis, shunt-dependent hydrocephalus and seizure, postclipping hemorrhagic complications (odds ratio 4.8, 95% confidence interval 1.5–15.3, P < 0.01), and postcoiling ischemic complications (odds ratio 4.4, 95% confidence interval 1.3–15.2, P < 0.05) significantly caused poor outcomes, although the complications did not affect mortality. Type of treatment modality and size and location of aneurysms did not influence outcome. Conclusions Introducing an endovascular treatment option has made aneurysm characteristics less important to outcome, but procedural complications are problematic and should be reduced to improve outcome.