Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage

Jaume Roquer, Elisa Cuadrado-Godia, Leopoldo Guimaraens, Gerardo Conesa, Ana Rodríguez-Campello, Jaume Capellades, María P. García-Arnillas, Juan L. Fernández-Candil, Carla Avellaneda-Gómez, Eva Giralt-Steinhauer, Jordi Jiménez-Conde, Carolina Soriano-Tárraga, Gloria Villalba-Martínez, Rosa M. Vivanco-Hidalgo, Elio Vivas, Angel Ois

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

OBJECTIVE: To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment. METHODS: In this prospective observational study, mortality and poor outcome (modified Rankin Scale score 3-6) were analyzed in 311 patients with aSAH at 3 months, 1 year, and 5 years follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed. RESULTS: Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months (odds ratio [OR] 0.36 [95% confidence interval [CI] 0.18-0.74]), with an absolute difference of 15.8% (number needed to treat = 6.3), and at 1 year (OR = 0.40 [95% CI 0.20-0.81]), with an absolute difference of 15.9% (number needed to treat = 6.3). Complications did not differ between the 2 procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR 0.67 [95% CI 0.54-0.84]). CONCLUSIONS: Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.

Original languageEnglish
Pages (from-to)e1819-e1829
JournalNeurology
Volume95
Issue number13
DOIs
StatePublished - Sep 29 2020

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