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Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage

BACKGROUND: The risk of rebleeding after aneurysmal subarachnoid hemorrhage (aSAH) is the highest during the initial hours after rupture. Emergency aneurysm treatment may decrease this risk, but is a logistic challenge and economic burden. We aimed to investigate whether aneurysm treatment <6 h a...

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Autores principales: Vergouwen, Mervyn DI, Germans, Menno R, Post, René, Tjerkstra, Maud A, Coert, Bert A, Rinkel, Gabriel JE, Peter Vandertop, William, Verbaan, Dagmar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10472949/
https://www.ncbi.nlm.nih.gov/pubmed/37641555
http://dx.doi.org/10.1177/23969873231173273
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author Vergouwen, Mervyn DI
Germans, Menno R
Post, René
Tjerkstra, Maud A
Coert, Bert A
Rinkel, Gabriel JE
Peter Vandertop, William
Verbaan, Dagmar
author_facet Vergouwen, Mervyn DI
Germans, Menno R
Post, René
Tjerkstra, Maud A
Coert, Bert A
Rinkel, Gabriel JE
Peter Vandertop, William
Verbaan, Dagmar
author_sort Vergouwen, Mervyn DI
collection PubMed
description BACKGROUND: The risk of rebleeding after aneurysmal subarachnoid hemorrhage (aSAH) is the highest during the initial hours after rupture. Emergency aneurysm treatment may decrease this risk, but is a logistic challenge and economic burden. We aimed to investigate whether aneurysm treatment <6 h after rupture is associated with a decreased risk of poor functional outcome compared to aneurysm treatment 6–24 h after rupture. METHODS: We used data of patients included in the ULTRA trial (NCT02684812). All patients in ULTRA were admitted within 24 h after aneurysm rupture. For the current study, we excluded patients in whom the aneurysm was not treated <24 h after rupture. We calculated crude and adjusted risk ratios (aRR) with 95% confidence intervals using Poisson regression analyses for poor functional outcome (death or dependency, assessed by the modified Rankin Scale) after aneurysm treatment <6 h versus 6–24 h after rupture. Adjustments were made for age, sex, clinical condition on admission (WFNS scale), amount of extravasated blood (Fisher score), aneurysm location, tranexamic acid treatment, and aneurysm treatment modality. RESULTS: We included 497 patients. Poor outcome occurred in 63/110 (57%) patients treated within 6 h compared to 145/387 (37%) patients treated 6–24 h after rupture (crude RR: 1.53, 95% CI: 1.24–1.88; adjusted RR: 1.36, 95% CI: 1.11–1.66). CONCLUSION: Aneurysm treatment <6 h is not associated with better functional outcome than aneurysm treatment 6–24 h after rupture. Our results do not support a strategy aiming to treat every patient with a ruptured aneurysm <6 h after rupture.
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spelling pubmed-104729492023-09-02 Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage Vergouwen, Mervyn DI Germans, Menno R Post, René Tjerkstra, Maud A Coert, Bert A Rinkel, Gabriel JE Peter Vandertop, William Verbaan, Dagmar Eur Stroke J Original Research Articles BACKGROUND: The risk of rebleeding after aneurysmal subarachnoid hemorrhage (aSAH) is the highest during the initial hours after rupture. Emergency aneurysm treatment may decrease this risk, but is a logistic challenge and economic burden. We aimed to investigate whether aneurysm treatment <6 h after rupture is associated with a decreased risk of poor functional outcome compared to aneurysm treatment 6–24 h after rupture. METHODS: We used data of patients included in the ULTRA trial (NCT02684812). All patients in ULTRA were admitted within 24 h after aneurysm rupture. For the current study, we excluded patients in whom the aneurysm was not treated <24 h after rupture. We calculated crude and adjusted risk ratios (aRR) with 95% confidence intervals using Poisson regression analyses for poor functional outcome (death or dependency, assessed by the modified Rankin Scale) after aneurysm treatment <6 h versus 6–24 h after rupture. Adjustments were made for age, sex, clinical condition on admission (WFNS scale), amount of extravasated blood (Fisher score), aneurysm location, tranexamic acid treatment, and aneurysm treatment modality. RESULTS: We included 497 patients. Poor outcome occurred in 63/110 (57%) patients treated within 6 h compared to 145/387 (37%) patients treated 6–24 h after rupture (crude RR: 1.53, 95% CI: 1.24–1.88; adjusted RR: 1.36, 95% CI: 1.11–1.66). CONCLUSION: Aneurysm treatment <6 h is not associated with better functional outcome than aneurysm treatment 6–24 h after rupture. Our results do not support a strategy aiming to treat every patient with a ruptured aneurysm <6 h after rupture. SAGE Publications 2023-05-01 2023-09 /pmc/articles/PMC10472949/ /pubmed/37641555 http://dx.doi.org/10.1177/23969873231173273 Text en © European Stroke Organisation 2023 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Articles
Vergouwen, Mervyn DI
Germans, Menno R
Post, René
Tjerkstra, Maud A
Coert, Bert A
Rinkel, Gabriel JE
Peter Vandertop, William
Verbaan, Dagmar
Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
title Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
title_full Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
title_fullStr Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
title_full_unstemmed Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
title_short Aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
title_sort aneurysm treatment within 6 h versus 6–24 h after rupture in patients with subarachnoid hemorrhage
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10472949/
https://www.ncbi.nlm.nih.gov/pubmed/37641555
http://dx.doi.org/10.1177/23969873231173273
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