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Byline: Jianfeng. Liu, Jian. Song, Di. Zhao, Hui. Li, Yingying. Lu, Guobiao. Wu, Kai. Hou, Xuan. Gao Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency with a high mortality [...]

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency with a high mortality and morbidity. There is a marked association of the ensuing neurological functional deficits following aSAH with the volume of hemorrhage. The volume of intracranial hemorrhage in aSAH is usually quantified by the revised Fisher grades.Materials and Methods: A total of 155 patients who suffered from aSAH were evaluated for risk factors that led to an increased volume of intracranial hemorrhage. These included various demographic factors, the medical history, the preadmission blood pressure, and the aneurysm characteristics.Results: The number of aneurysms was significantly related to poor revised Fisher grades (grade 3 or 4; P = 0.016). Thus, the presence of multiple aneurysms (2-4) was a significant risk factor responsible for a poor modified Fisher grade (odds ratio [OR] = 4.0, P = 0.004). Significantly higher risk of intracranial hemorrhage was also observed for aneurysms located on the the internal carotid artery (ICA), anterior communicating artery (ACOA), or middle cerebral artery (MCA) when compared with other sites (P < 0.001). Bleeding in ACOA was significantly associated with a poor Fisher's grade (OR = 4.3, P = 0.025). Additionally, the preadmission diastolic blood pressure (DBP) alone was significantly associated with a poor Fisher grade (P = 0.024).Conclusion: Preadmission DBP, multiple aneurysms, and aneurysms of the ACOA are associated with markedly increased volume of hemorrhage as evaluated by the revised Fisher grades. Thus, patients harboring an intracranial aneurysm having the above mentioned features should seek an early intervention in order to prevent the occurrence of aSAH. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness and safety of self-expanding stent in treatment of acutely ruptured wide-necked intracranial aneurysms in the acute stage., Method: Treatment of 38 patients with self-expanding stent was retrospectively analyzed., Results: From January 2009 to May 2014, a total of 38 patients with 44 acutely ruptured wide-necked intracranial aneurysms were embolized with self-expanding stents at our center. Immediate post-operative imaging demonstrated that the aneurysms were densely packed in 17 patients, subtotally embolized in 2 patients, and subtotally embolized with residual aneurysm necks in 19 patients. At discharge, the patients were assessed for prognosis and the results revealed nerve dysfunction in 3 patients (7.9%), coma in 6 patients (15.8%), hospital death in 1 case (2.6%). Twenty-eight (73.7%) patients were asymptomatic at discharge. Ten of the 38 patients were followed up by angiography for a period of 3.7 months on average, which showed complete occlusion in 9 patients (90%), remnant aneurysm necks in 1 patient (10%), and no recanalization was observed in all the followed-up patients. Stent related complications also were recorded., Conclusion: Stent-assisted coiling is effective in treating acutely ruptured wide-necked intracranial aneurysms. Angiographic investigation and clinical follow-up is needed for evaluation of long-term clinical outcomes.