Aneurysmal Subarachnoid Hemorrhage: Risk Assessment and Perioperative Complications

2019 ◽  
pp. 63-66
Author(s):  
Chanhung Z. Lee ◽  
Pekka Talke ◽  
Nerissa U. Ko
Keyword(s):  
Risk Assessment ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Perioperative Complications ◽  
Hemorrhage Risk

303 Aneurysmal Subarachnoid Hemorrhage Patientsʼ Risk Assessment for Shunting (aSAH-PARAS)

Neurosurgery ◽  
2016 ◽  
Vol 63 ◽  
pp. 186-187
Author(s):  
Hadie Adams ◽  
Vin Shen Ban ◽  
Ville Leinonen ◽  
Salah G. Aoun ◽  
Jukka Huttunen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage

scholarly journals Operative complications and differences in outcome after clipping and coiling of ruptured intracranial aneurysms

2015 ◽  
Vol 123 (3) ◽  
pp. 621-628 ◽  
Author(s):  
Oliver G. S. Ayling ◽  
George M. Ibrahim ◽  
Brian Drake ◽  
James C. Torner ◽  
R. Loch Macdonald
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Perioperative Complications ◽  
Endovascular Coiling ◽  
Multivariate Logistic Regression ◽  
Long Term Outcomes ◽  
Improved Outcomes ◽  
Post Hoc

OBJECT Aneurysmal subarachnoid hemorrhage (aSAH) is associated with substantial morbidity and mortality, with better outcomes reported following endovascular coiling compared with neurosurgical clipping of the aneurysm. The authors evaluated the contribution of perioperative complications and neurological decline to patient outcomes after both aneurysm-securing procedures. METHODS A post hoc analysis of perioperative complications from the Clazosentan to Overcome Neurological iSChemia and Infarction Occurring after Subarachnoid hemorrhage (CONSCIOUS-1) study was performed. Glasgow Coma Scale (GCS) scores for patients who underwent neurosurgical clipping and endovascular coiling were analyzed preoperatively and each day following the procedure. Complications associated with a decline in postoperative GCS scores were identified for both cohorts. Because patients were not randomized to the aneurysm-securing procedures, propensity-score matching was performed to balance selected covariates between the 2 cohorts. Using a multivariate logistic regression, the authors evaluated whether a perioperative decline in GCS scores was associated with long-term outcomes on the extended Glasgow Outcome Scale (eGOS). RESULTS Among all enrolled subjects, as well as the propensity-matched cohort, patients who underwent clipping had a significantly greater decline in their GCS scores postoperatively than patients who underwent coiling (p = 0.0024). Multivariate analysis revealed that intraoperative hypertension (p = 0.011) and intraoperative induction of hypotension (p = 0.0044) were associated with a decline in GCS scores for patients undergoing clipping. Perioperative thromboembolism was associated with postoperative GCS decline for patients undergoing coiling (p = 0.03). On multivariate logistic regression, postoperative neurological deterioration was strongly associated with a poor eGOS score at 3 months (OR 0.86, 95% CI 0.78-0.95, p = 0.0032). CONCLUSIONS Neurosurgical clipping following aSAH is associated with a greater perioperative decline in GCS scores than endovascular coiling, which is in turn associated with poorer long-term outcomes. These findings provide novel insight into putative mechanisms of improved outcomes following coiling, highlighting the potential importance of perioperative factors when comparing outcomes between clipping and coiling and the need to mitigate the morbidity of surgical strategies following aSAH.

Who is Likely to Present in Poor Neurologic Condition After Aneurysmal Subarachnoid Hemorrhage? Risk Factors and Implications for Treatment

2016 ◽  
Vol 92 ◽  
pp. 113-119 ◽  
Author(s):  
Michelle H. Chua ◽  
Christoph J. Griessenauer ◽  
Ajith J. Thomas ◽  
Christopher S. Ogilvy
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hemorrhage Risk

Organization of Surgical Care for Patients with Aneurysmal Subarachnoid Hemorrhage in a Large Region of Russia (According to the Republic Of Tatarstan)

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
Valery Danilov ◽  
Andrey Alekseev ◽  
Michail Volodjkhin ◽  
Aleksandr Nemirovsky ◽  
Nail Shayakhmetov ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Surgical Care ◽  
Large Region ◽  
The Republic
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