Abstract
Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not well-defined. Identifying them would be beneficial in determining which patients might benefit from ET. To identify the predictive factors for poor outcomes following ET for aSAH. 120 patients with ruptured cerebral aneurysms underwent endovascular embolization between January 2017 and December 2018. Blood pressure variability was examined using the standard deviation of the 24-hour systolic blood pressure (24hSSD) and 24-hour diastolic blood pressure (24hDSD). Predictors were identified through univariate and multivariate regression analysis. All patients were followed up for three months. At follow-up, 86 patients (71.7%) had good outcomes and 34 (28.3%) had poor outcomes. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The 24hDSD did not differ significantly between patients with good outcomes and those with poor outcomes (9.5 ± 2.3 vs 9.9 ± 3.5 mmHg; P = 0.464). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0-175.9; P = 0.002); Hunt-Hess grade 3-4 (OR = 6.8; 95% CI: 1.1-33.7; P = 0.039); Fisher grade 3-4 (OR = 47.1; 95% CI: 3.8-586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1-34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0-55.2; P < 0.001). Elevated 24hSSD is a possibly treatable predictive factor for poor outcomes after ET for aSAH.
Highlights
Cerebral aneurysm is a local cystic swelling in the brain that is caused by a defect in the vascular wall
In the logistic regression analysis, the outcome was used as the response variable; and age ≥ 65 years, Hunt-Hess grade [3,4], Fisher grade [3,4], postoperative complications, intraoperative complications, 24-hour systolic blood pressure (24hSSD) ≥ 15 mmHg and 24-hour diastolic blood pressure (24hDSD) ≥ 9 mmHg were used as the explanatory variables
Our study found that age ≥ 65 years, Hunt-Hess grade [3,4], Fisher grade [3,4], postoperative complications and 24hSSD ≥ 15 mmHg were risk factors and determinants for poor outcomes after endovascular treatment for aneurysmal subarachnoid hemorrhage (aSAH)
Summary
Cerebral aneurysm is a local cystic swelling in the brain that is caused by a defect in the vascular wall. Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not welldefined. Objective:To identify the predictive factors for poor outcomes following ET for aSAH. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0–175.9; P = 0.002); Hunt-Hess grade [3,4] (OR = 6.8; 95% CI: 1.1–33.7; P = 0.039); Fisher grade [3,4] (OR = 47.1; 95% CI: 3.8–586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1–34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0–55.2; P < 0.001).
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