Correlation between timing of treatment and clinical prognosis of patients with high-grade aneurysmal subarachnoid hemorrhage
LI Kai
YUE Xin-can
WANG Chang-wei
LIU Xiao
Shi Peng-fei
HE Bing
ZHAO Yu-tao
LIU De-zhong
Abstract：Objective To investigate the relationship between the timing of treatment and clinical outcomes in patients with high-grade(Hunt-Hess grades 4-5)aneurysmal subarachnoid hemorrhage(aSAH).Methods A retrospective analysis was conducted on 81 patients with high-grade aSAH admitted to our hospital from January 2018 to January 2022.Three months after surgery,delayed cerebral ischemia(DCI)was diagnosed based on clinical manifestations or CT findings,and the modified Rankin Scale(mRS)score was used to evaluate outcomes,with a score of 3～5 indicating poor prognosis.Results Of the 81 patients,36 patients underwent microsurgical clipping and 45 underwent endovascular embolization.Treatment was initiated within 3 days of onset in 54 patients,between 3～10 days in 23 patients,and after 10 days in 4 patients.Thirty-two patients(39.5％,32/81)had DCI,with DCI rates of 41.7％(15/36)and 37.8％(17/45)in the clipping and coiling groups,respectively.A total of 46 patients(56.8％)had poor outcomes.Multivariate logistic regression analysis showed a significantly increased risk of DCI in patients receiving treatment between 3～10 days of onset(OR=2.88;95％CI 1.03-8.00;P=0.043).Univariate analysis indicated that treatment timing,age＞55 years,and intraventricular hemorrhage volume＞30 ml were associated with poor outcomes at 3 months after surgery(P＜0.05).Subgroup analysis revealed that patients＞55 years old(OR=23.26;95％ CI 1.63-332.25;P=0.020)and those with acute hydrocephalus(OR=9.29;95％ CI 1.06-81.27;P=0.044)or intraventricular hemorrhage(OR=7.43;95％ CI 1.72-32.12;P=0.007)had a significantly increased risk of poor outcomes when treated between 3～10 days of onset.Conclusions Treatment of high-grade aSAH within 3～10 days of onset may be associated with worse outcomes.Early intervention is recommended for patients over 55 years old with acute hydrocephalus or intraventricular hemorrhage.
Keywords：High-grade aneurysmal subarachnoid hemorrhageDelayed cerebral ischemiaPrognosisTreatment timing
Publication Date：2023-12-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 696-700 )