1. Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage.
- Author
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Wong GK, Boet R, Ng SC, Chan M, Gin T, Zee B, and Poon WS
- Subjects
- Aged, Aneurysm, Ruptured surgery, Cerebral Angiography, Confidence Intervals, Female, Humans, Hypertension complications, Male, Middle Aged, Neuropsychological Tests, Odds Ratio, Prognosis, Prospective Studies, Recurrence, Surgical Instruments, Treatment Outcome, Intracranial Aneurysm surgery, Neurosurgical Procedures, Subarachnoid Hemorrhage surgery
- Abstract
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., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
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