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See Latest ArticlesInterdisciplinary treatment selection in admitted patients with acute subarachnoid hemorrhage
Neurological Research, 08/06/09
Carvi y Nievas MN et al. – Comparative literature analysis shows that acute interdisciplinary treatment of pts with subarachnoid hemorrhage (SAH) increases the rate of aneurysm occlusion, improves the pt evolution, and reduces the number of complications.
Methods- Review of angiographic and clinical outcomes from acute (first 6 hrs after bleeding) interdisciplinary-treated pts with ruptured intracranial aneurysm
- Emergent treatment determined by an interventional neuroradiologist and a neurosurgeon
- Assessment of 100 consecutive pts with SAH harboring 111 cerebral aneurysms
- Decisions based on pt clinical condition, aneurysm's morphology and location, presence of intracranial mass-occupying process (IMOP), angiographic flow distribution patterns, and treatment-related risk profit
- Retrospective analysis of the benefits of a joined case assessment
- Comparison of clinical and radiological results vs averaged literature series
- Initially, 39 aneurysms in 34 pts endovascularly (EV) treated; 68 aneurysms in 66 pts surgically (S) treated; 4 nonruptured aneurysms remain under control
- Complete radiological aneurysm occlusion initially achieved in 35 (89.7%) EV and 62 (95.4%) S treated aneurysms
- 26 pts in poor clinical condition with IMOP; 10 pts with distally located, 18 with EV unfavorable, and 12 with highly expected recanalization rate aneurysms required S treatment
- 4 aneurysm remnants (2 EV and 2 S) remain unchanged
- 2 EV treated aneurysms grew, then surgically occluded; additional coiling procedure after recanalization required for another 3 pts
- Favorable evolution in 27 (79.4%) EV and 55 (83.3%) S treated pts
- Method-related complications in the EV and S groups, CT-documented rebleedings (7:1), angiographic vasospasm (3:5) and occlusion of main vessels (2:2), respectively
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