Abstract
ObjectiveThe influence of preexisting factors on the clinical course of patients with subarachnoid hemorrhage (SAH), such as patient age, arterial hypertension, and aneurysm characteristics, is still a matter of debate. However, the specific impact of the exact aneurysm location has not received adequate attention. Therefore, the aim of this study was to investigate the influence of aneurysm location as a preexisting factor on the clinical course and mortality.MethodsThe data of consecutive patients with aneurysmal SAH who were treated from October 2010 to July 2020 were retrospectively analyzed. We distinguished four aneurysm locations: the anterior complex, internal carotid artery (ICA), middle cerebral artery (MCA), and posterior circulation. Logistic regression analysis and receiver operating characteristics were used to investigate the influence of aneurysm location on the occurrence of acute hydrocephalus, Delayed Cerebral Ischemia (DCI), neurological outcome, and in-hospital mortality. Neurological outcome was assessed 3 months after discharge using the Glasgow Outcome Scale.ResultsA total of 603 patients were included in this study. Patients with MCA aneurysms were 2.52 times less likely to develop acute hydrocephalus compared to patients with anterior complex aneurysms (p = 0.001). Delayed cerebral ischemia occurred most frequently in patients with an anterior complex aneurysm and least frequently in MCA aneurysms (p = 0.014). In ICA aneurysms, mortality was 2.56-fold higher than in patients with aneurysms of the anterior complex (p = 0.006). An additional ROC analysis showed a good prediction for in-hospital mortality when taking the aneurysm's location into account [AUC.855 (CI.817 −0.893)].ConclusionsThe aneurysm's location proved to be a significant predictor of acute hydrocephalus, DCI, and in-hospital mortality, demonstrating the impact of this preexisting biological factor on the course of SAH.
Highlights
Aneurysmal subarachnoid hemorrhage (SAH) remains a disease with high morbidity and mortality rates [1]
As for location, it has been repeatedly postulated that patients with SAH from a posterior circulation aneurysm are likely to have a worse outcome [3, 6, 7]
All patients treated at our institution with an aneurysmal SAH from October 2010 to July 2020 who were 18 years or older were included in this retrospective single-center study
Summary
Aneurysmal subarachnoid hemorrhage (SAH) remains a disease with high morbidity and mortality rates [1]. As for location, it has been repeatedly postulated that patients with SAH from a posterior circulation aneurysm are likely to have a worse outcome [3, 6, 7] Apart from this categorical subdivision, a more refined analysis related to the different vascular territories is needed to explore possible prognostic clues [4, 5, 8]. The aim of our work was to investigate whether in a large institutional cohort within a homogenous treatment regimen, the aneurysm’s location, as a biological factor, can provide a clue for estimating clinical course and in-hospital mortality. This knowledge could improve the prognostic estimation complementary to existing scores
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