Roquer Jaume, Cuadrado-Godia Elisa, Guimaraens Leopoldo, Conesa Gerardo, Rodríguez-Campello Ana, Capellades Jaume, García-Arnillas María P, Fernández-Candil Juan L, Avellaneda-Gómez Carla, Giralt-Steinhauer Eva, Jiménez-Conde Jordi, Soriano-Tárraga Carolina, Villalba-Martínez Gloria, Vivanco-Hidalgo Rosa M, Vivas Elio, Ois Angel
From Servei de Neurologia (J.R., E.C.-G., A.R.-C., C.A.-G., E.G.-S., J.J.-C., C.S.-T., R.M.V.-H., A.O.), Departament J Merland de Neuroangiografia Terapèutica (L.G., E.V.), Servei de Neurocirurgia (G.C., G.V.-M.), Servei de Neuroradiologia (J.C.), Servei de Medicina Intensiva (M.P.G.-A.), and Servei d'Anestèsia i Reanimació (J.L.F.-C.), IMIM-Hospital del Mar, Barcelona; and Departament de Medicina (J.R., E.C.-G., A.R.-C., A.O.), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Spain.
Neurology. 2020 Sep 29;95(13):e1819-e1829. doi: 10.1212/WNL.0000000000010618. Epub 2020 Aug 13.
To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment.
In this prospective observational study, mortality and poor outcome (modified Rankin Scale score 3-6) were analyzed in 311 patients with aSAH at 3 months, 1 year, and 5 years follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed.
Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months (odds ratio [OR] 0.36 [95% confidence interval [CI] 0.18-0.74]), with an absolute difference of 15.8% (number needed to treat = 6.3), and at 1 year (OR = 0.40 [95% CI 0.20-0.81]), with an absolute difference of 15.9% (number needed to treat = 6.3). Complications did not differ between the 2 procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR 0.67 [95% CI 0.54-0.84]).
Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.
描述接受修复治疗的自发性动脉瘤性蛛网膜下腔出血（aSAH）患者的短期和5年死亡率及不良预后情况。
在这项前瞻性观察研究中，对311例aSAH患者在3个月、1年和5年随访时的死亡率及不良预后（改良Rankin量表评分3 - 6分）进行分析。根据治疗方式进行敏感性分析。分析住院期间及5年的并发症情况。
在476例连续的自发性蛛网膜下腔出血患者中，347例（72.9%）为aSAH。其中，311例（89.6%）接受了治疗（242例血管内治疗，69例神经外科手术），平均随访43.4个月（范围1至145个月）。3个月、1年和5年的死亡率分别为18.4%、22.9%和29.0%，不良预后分别为42.3%、36.0%和36.0%。在3个月时，血管内治疗调整后的不良预后低于神经外科治疗（优势比[OR] 0.36 [95%置信区间[CI] 0.18 - 0.74]），绝对差异为15.8%（治疗所需人数 = 6.3）；在1年时，（OR = 0.40 [95% CI 0.20 - 0.81]），绝对差异为15.9%（治疗所需人数 = 6.3）。两种手术的并发症无差异。然而，血管内技术的机械通气频率较低（OR 0.67 [95% CI 0.54 - 0.84]）。
按照现行指南治疗的aSAH患者短期死亡率为18.4%，5年死亡率为29%。大多数（64.0%）患者在5年随访时存活且无残疾。因血管内栓塞不可行而优先接受血管内治疗的患者比接受神经外科手术的患者预后更好。
