Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Berlin, Germany.
Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
World Neurosurg. 2024 Apr;184:e720-e730. doi: 10.1016/j.wneu.2024.02.018. Epub 2024 Feb 8.
Aneurysmal subarachnoid hemorrhage (aSAH) from a ruptured intracranial aneurysm is a severe, life-threatening condition, with high morbidity and mortality. The current treatment often involves surgical clipping or endovascular treatment within the first 24-48 hours. Although there is ample evidence of complications in treating unruptured aneurysms, similar data in patients with acutely ruptured aneurysms are limited. The recently completed EARLYDRAIN trial showed improved neurologic results from lumbar drainage after aneurysm treatment in patients with aSAH. Using this data set, we aim to study the frequency and effects of complications and identify associated risk factors.
A substudy was carried out of the prospective multicenter randomized controlled EARLYDRAIN trial. We analyzed treatment-associated complications (bleeding and/or infarctions) detected on computed tomography on day 1 after aneurysm occlusion. Outcomes were the occurrence of postprocedural complications, secondary infarctions in the acute phase, and the modified Rankin Scale score after 6 months.
The EARLYDRAIN trial recruited 287 patients in 19 centers. Of these patients, 56 (19.5%) experienced a treatment complication. Twenty-five patients (8.7%) experienced postprocedural intracranial hemorrhage and 34 patients (11.8%) experienced a treatment-associated infarction. Patients with a complication showed more secondary infarctions (P = 0.049) and worse neurologic outcomes after 180 days (P = 0.025) compared with patients with no complication. Aneurysm location, rebleeding before the treatment, number of patients recruited per center, and the day of the treatment were independent risk factors for the occurrence of complications.
The present study shows that patients with aSAH frequently experience intervention-associated complications associated with aneurysm occlusion required to prevent recurrent hemorrhage. Consequently, patients with aSAH with treatment-related complications more often experience a worse clinical course and poor outcome.
颅内破裂动脉瘤引起的蛛网膜下腔出血（aSAH）是一种严重的、危及生命的疾病，具有较高的发病率和死亡率。目前的治疗通常包括在发病后 24-48 小时内进行手术夹闭或血管内治疗。尽管有大量证据表明治疗未破裂的动脉瘤会引起并发症，但在急性破裂的动脉瘤患者中，类似的数据有限。最近完成的 EARLYDRAIN 试验表明，在 aSAH 患者接受动脉瘤治疗后进行腰椎引流可改善神经学结果。利用这个数据集，我们旨在研究并发症的发生频率和影响，并确定相关的危险因素。
对前瞻性多中心随机对照 EARLYDRAIN 试验进行了一项亚研究。我们分析了在动脉瘤闭塞后第 1 天的 CT 上发现的与治疗相关的并发症（出血和/或梗死）。结果是术后并发症的发生、急性期的继发性梗死以及 6 个月后的改良 Rankin 量表评分。
EARLYDRAIN 试验在 19 个中心招募了 287 名患者。这些患者中，有 56 名（19.5%）发生了治疗并发症。25 名患者（8.7%）发生了术后颅内出血，34 名患者（11.8%）发生了与治疗相关的梗死。与无并发症的患者相比，有并发症的患者出现更多的继发性梗死（P=0.049）和 180 天后更差的神经学结局（P=0.025）。动脉瘤位置、治疗前再出血、每个中心招募的患者数量和治疗日是并发症发生的独立危险因素。
本研究表明，aSAH 患者经常经历与防止再出血相关的介入治疗相关的并发症。因此，有治疗相关并发症的 aSAH 患者更常经历不良的临床过程和较差的结局。
