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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2023
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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. |
format | Online Article Text |
id | pubmed-10472949 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
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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