Roethlisberger Michel, Achermann Rita, Bawarjan Schatlo, Stienen Martin N, Fung Christian, D'Alonzo Donato, Maldaner Nicolai, Ferrari Andrea, Corniola Marco V, Schöni Daniel, Goldberg Johannes, Valsecchi Daniele, Robert Thomas, Maduri Rodolfo, Seule Martin A, Burkhardt Jan-Karl, Marbacher Serge, Bijlenga Philippe, Blackham Kristine A, Bucher Heiner C, Mariani Luigi, Guzman Raphael, Zumofen Daniel W
Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland.
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland.
Neurosurgery. 2019 Jun 1;84(6):E334-E344. doi: 10.1093/neuros/nyy331.
One-third of patients with aneurysmal subarachnoid hemorrhage (aSAH) have multiple intracranial aneurysms (MIA).
To determine the predictors of outcome in aSAH patients with MIA compared to aSAH patients with a single intracranial aneurysm (SIA).
The Swiss Study of Subarachnoid Hemorrhage dataset 2009-2014 was used to evaluate outcome in aSAH patients with MIA compared to patients with SIA with the aid of descriptive and multivariate regression analysis. The primary endpoints of this cohort study were presence of new stroke on computed tomography (CT) after aneurysm treatment, and presence of stroke on CT prior to discharge. The secondary endpoints were the clinical and the functional status, and the overall mortality at discharge and at 1 yr.
Among 1689 consecutive patients, 467 had MIA (prevalence: 26.4%). The incidence of stroke was higher in the MIA than in the SIA group, both after aneurysm treatment (19.3% vs 15.1%) and at discharge (24% vs 21.4%). However, the 95% confidence interval (CI) for the corresponding odds ratio (OR) in our multivariate model included 1, indicating that the detected trends did not reach statistical significance. As for the secondary endpoints, aneurysm multiplicity was found to be an independent, statistically significant predictor for occurrence of a new focal neurological deficit between admission and discharge (OR 1.40, 95% CI 1.08-1.81). Yet, the MIA and SIA groups did not differ in terms of either functional outcome or overall survival.
aSAH patients with MIA have a higher short-term morbidity than patients with SIA. This excess morbidity does not worsen the functional outcome or lower overall survival.
三分之一的动脉瘤性蛛网膜下腔出血（aSAH）患者患有多发性颅内动脉瘤（MIA）。
确定与单发性颅内动脉瘤（SIA）的aSAH患者相比，MIA的aSAH患者的预后预测因素。
使用2009 - 2014年瑞士蛛网膜下腔出血研究数据集，通过描述性和多变量回归分析，评估MIA的aSAH患者与SIA患者的预后。本队列研究的主要终点是动脉瘤治疗后计算机断层扫描（CT）上出现新的卒中，以及出院前CT上出现卒中。次要终点是临床和功能状态，以及出院时和1年时的总死亡率。
在1689例连续患者中，467例患有MIA（患病率：26.4%）。动脉瘤治疗后（19.3%对15.1%）和出院时（24%对21.4%），MIA组的卒中发生率均高于SIA组。然而，我们多变量模型中相应优势比（OR）的95%置信区间（CI）包含1，表明检测到的趋势未达到统计学显著性。至于次要终点，发现动脉瘤多发性是入院和出院之间出现新的局灶性神经功能缺损的独立、统计学显著预测因素（OR 1.40，95%CI 1.08 - 1.81）。然而，MIA组和SIA组在功能结局或总生存率方面没有差异。
MIA的aSAH患者的短期发病率高于SIA患者。这种额外的发病率并未使功能结局恶化或降低总生存率。
