Abstract Details

Title Effect of Ultra-Early Endovascular Intracranial Aneurysm Treatment on Rebleeding and Outcomes in Patients with Subarachnoid Hemorrhage

Topic Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 092

Objective

Background BACKGROUND: The American Heart Association (AHA) recommends early aneurysm treatment without specifying specific time intervals in patients with subarachnoid hemorrhage (SAH) [Bederson JB, et al. Stroke. 2009;40:994-1025]. The AHA further requires Comprehensive Stroke Centers to document the proportion of SAH patients treated within 36 hours after admission as a Quality of Care metric. [Leifer D, et al. Stroke. 2011; 42: 849-877] However, the definition of early treatment remains controversial.

Design/Methods DESIGN/METHODS: We analyzed the data from 144 consecutive SAH patients from two academic centers who underwent endovascular treatment of ruptured intracranial aneurysms over a period of 4 years. Pre-procedure rebleeding was defined as an acute neurological deterioration associated with new hemorrhage apparent on a computed tomographic (CT) scan or an increase in hemorrhage burden on a repeat CT scan. Favorable outcome was defined as modified Rankin score of ?2 at discharge. Baseline characteristics and outcomes were compared between ultra-early (<12 hours) and delayed (?12 hours) treatment using univariate analysis and multivariate analysis after adjustment for confounders.

Results RESULTS: Of the 144 SAH patients (mean age 54±SD: 13). Ninety nine (68%) were women who underwent endovascular intracranial aneurysm treatment, (58%) underwent ultra-early aneurysm treatment. After adjusting for age, Hunt & Hess scores, and Fisher grades, there was no significant difference in rates of favorable outcomes (odd ratio [OR] 0.6, 95% confidence interval [CI] 0.2-1.3) or in-hospital mortality (OR 0.8, 95% CI 0.3-2.3) between the two groups. Pre-procedure rebleeding was less likely to occur in the ultra-early treatment group (OR 0.1; 95% CI 0.02-0.4, p<0.002).

Conclusions CONCLUSIONS: Ultra-early aneurysm treatment is possible due to the availability of endovascular treatment and appears to significantly reduce pre-procedural rebleeding rates in patients with SAH.

Authors/Disclosures
Nathan H. Sit, MD PRESENTER	No disclosure on file
Nauman Tariq, MD	Dr. Tariq has received personal compensation for serving as an employee of NC neurological society .
	No disclosure on file
Aaron E. Miller, MD, FAAN (Mt Sinai School Of Med)	Dr. Miller has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Accordant Health Services (Caremark). Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Corevitas (formerly known as Corrona). Dr. Miller has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MAPI=Pharma. Dr. Miller has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Viatris (Mylan). Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gerson Lehrman Group. Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen Idec. Dr. Miller has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen (Horizon Therapeutics). Dr. Miller has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Sterne Kessler. Dr. Miller has received publishing royalties from a publication relating to health care.
	No disclosure on file
Waqas I. Gilani, MD (Neurology Consultants of North Mississippi)	Dr. Gilani has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

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