Timing of treatment on the prognosis of poor-grade aneurysmal subarachnoid hemorrhage patients

Abstract

To explore the prognostic effects of ultra-early, early, medium-term and late treatments of poor-grade aneurysm patients. A total of 119 patients of WFNS IV and V, including WFNS IV grade (n = 73) and V grade (n = 46), were analyzed. There were 51 males and 68 female with a mean age of 55.2 years. Among them, 57 cases underwent surgical clipping, including ultra-early treatment (n = 2), early treatment (n = 14), medium-term treatment (n = 28) and late treatment (n = 13); 40 cases underwent interventional embolization, including ultra-early treatment (n = 14), early treatment (n = 16), medium-term treatment (n = 8), late treatment (n = 2) and conservative treatment (n = 22). The outcomes were assessed according to the Glasgow outcome score during a 3-month follow-up. There was 0 case of a good prognosis in surgical clipping group with ultra-early treatment versus 13 of good prognosis in interventional embolization group; poor prognosis 2 vs 0 and death 0 vs 1 in two groups respectively. Early treatment: good prognosis 5 vs 13; poor prognosis 9 vs 0; death 0 vs 3; Medium-term treatment: good prognosis 17 vs 0; poor prognosis 10 vs 0; death 1 vs 8; Late treatment: good prognosis 0 vs 0; poor prognosis 9 vs 1; death 4 vs 1. For patients of WFNS IV grade, the treatment should be performed as soon as possible. For patients in WFNS V grade, ultra-early and early treatments fare better than medium-term and late treatments. The mortality of medium-term treatment is the highest. Overall prognosis of late treatment has the worst outcome. Regardless of treatment period, conservative treatment shows the worst prognosis and the highest mortality.