J Neurointensive Care.  2020 Oct;3(2):33-41. 10.32587/jnic.2020.00269.

Predictors for Unfavorable Outcomes and Recurrence after Endovascular Treatment for Ruptured Intracranial Aneurysms

• Kim J
• Roh H
• Suh Si
• Kwon TH
• Yoon WK

• KMID: 2555037
• DOI: http://doi.org/10.32587/jnic.2020.00269

Abstract

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.

Keyword

Endovascular treatment; Predictor; Subarachnoid hemorrhage; Unfavorable outcome; Modified rankin scale; Recurrence; Coil