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KMID : 1148420200030020033
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Journal of Neurointensive Care
2020 Volume.3 No. 2 p.33 ~ p.41
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Predictors for Unfavorable Outcomes and Recurrence after Endovascular Treatment for Ruptured Intracranial Aneurysms
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Kim Jun-Won
Roh Hae-Won
Suh Sang-Il
Kwon Taek-Hyun
Yoon Won-Ki
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Abstract
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Objective: With current increase in the use endovascular treatment (EVT) for ruptured aneurysms, it is important to recognize factors associated with unfavorable outcomes and recurrence in patients with subarachnoid hemorrhage (SAH) treated with endovascular coiling. This study aimed to identify the predictors of unfavorable outcomes and recurrence in patients who received EVT for ruptured aneurysms.
Methods: 102 patients who were treated with an endovascular procedure for a ruptured aneurysm, including both stent-assisted and non-stent-assisted coil embolizations, were enrolled in this study. A retrospective analysis was performed to identify significant predictors of unfavorable outcomes and recurrence.
Results: At the last follow-up, 72 patients (70.59%) showed a favorable outcome (modified Rankin Scale [mRS] score: 0?2), while 30 patients (29.41%) showed an unfavorable outcome (mRS score: 3?6). In the univariate and multivariate logistic regression analyses, the following variables were found to be the significant predictors of unfavorable outcomes among patients with all-grade SAH: initial Hunt?Hess grade (p = 0.02), periprocedural complications (p = 0.01), and external ventricular drainage (EVD) (p = 0.03), while those among patients with good-grade SAH (Hunt?Hess grades 1?3) were as follows: age (p = 0.009), re-bleeding before treatment (p = 0.002), EVD (p = 0.003), and delayed cerebral ischemia (p = 0.04). Further, the aneurysm volume (p = 0.043) and initial Raymond classification (p = 0.04) were found to be significantly correlated with recurrence.
Conclusion: There are various predictors of unexpected unfavorable outcomes and recurrence in patients who receive EVT for ruptured aneurysms. Therefore, careful individualized consideration is necessary for patients with acute SAH who plan to receive EVT.
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KEYWORD
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Endovascular treatment, Risk factors, Patient outcome assessment, Treatment outcome, Subarachnoid hemorrhage.
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