Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-30T19:13:43.020Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Outcomes After Endovascular Coiling in High-Grade Aneurysmal Hemorrhage

Published online by Cambridge University Press:  23 July 2018

Roberto Jose Diaz  and
John H. Wong
Roberto Jose Diaz
Affiliation:
Division of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
John H. Wong*
Affiliation:
Division of Neurosurgery, Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
*
Division of Neurosurgery, Department of Clinical Neurosciences, 12th Floor, Foothills Medical Centre, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Object:

Our experience in Calgary was reviewed to determine the safety and clinical effectiveness of coiling in patients with high-grade aneurysmal subarachnoid hemorrhage (SAH).

Methods:

Patients with Hunt-Hess grades IV and V aneurysmal subarachnoid hemorrhage who underwent endovascular coiling between January 1999 and April 2009 at Foothills Medical Centre, Calgary, Alberta, Canada were reviewed. The primary outcome measure was the Modified Rankin Score after at least six months. Secondary outcome measures included extent of aneurysm occlusion and peri-procedural complications. In patients with favourable functional outcomes, Barthel's Index (BI), Re-integration to normal living index (RINL), and Zung depression scale (ZDS) were determined.

Results:

Thirty-three patients were identified (median age of 57 years; 73% female) and 69% were Hunt-Hess grade IV subarachnoid hemorrhage and 22 % were grade V Endovascular coiling resulted in absence of residual flow into the aneurysm fundus in 91%. Only seven procedure-related complications occurred with no deaths attributed to the procedure. Vasospasm, hydrocephalus, and pneumonia were the most common non-procedural complications. Average follow-up was 27 +/- 17 months. Overall mortality was 32%, but 53% of patients had good functional outcome (mRS<3). Nine patients completed the BI, RINL, and ZDS with average BI 99 +/- 2, RINL 89 +/- 14, ZDS 33 +/-11, suggesting minimal deficits in function and mood.

Conclusions:

Endovascular coiling in patients with high-grade subarachnoid hemorrhage is safe. While the morbidity and mortality from high-grade aneurysmal subarachnoid hemorrhage remains significant, favourable radiologic and functional outcomes can be achieved in a significant proportion of these critically ill patients.

Résumé:

Résumé:Objet:

Notre expérience à Calgary a été révisée afin de déterminer la sécurité et l'efficacité clinique de l'embolisation endovasculaire de microspires chez les patients atteints d'une hémorragie sous-arachnoïdienne (HSA) anévrismale de haut grade.

Méthodes:

Les dossiers des patients atteints d'hémorragie sous-arachnoïdienne anévrismale de grade IV et V à l'échelle Hunt-Hess, qui ont subi une embolisation endovasculaire par microspires entre Janvier 1999 et avril 2009 au Foothills Medical Centre, à Calgary, Alberta, Canada, ont été révisés. La mesure principale des résultats était le score à l'échelle modifiée de Rankin au moins six mois après l'intervention. Les mesures secondaires de résultats comprenaient le degré d'occlusion de l'anévrisme et les complications périopératoires. Chez les patients qui ont eu des résultats fonctionnels favorables, I'indice de Barthel (IB), I'indice de réintégration à la vie normale (IRVL) et le score à l'échelle de dépression de Zung (EDZ) ont été mesurés.

Résultats:

Trente-trois patients ont été identifiés (âge médian 57 ans; 73% de femmes) dont 69% avaient une HSA de grade IV à l'échelle Hunt-Hess et 22% une HSA de grade V. Suite à l'embolisation endovasculaire, il n'y avait aucun flux résiduel dans le fond du sac anévrismal chez 91% des patients. Seulement sept complications reliées à l'intervention ont été observées et aucun décès n'a été attribué à l'intervention. Les complications les plus fréquentes, non reliées à l'intervention, étaient le vasospasme, l'hydrocéphalie et la pneumonie. La durée moyenne du suivi était de 27 ± 17 mois. La mortalité globale a été de 32% et 53% des patients ont eu un bon résultat fonctionnel (MRS < 3). Neuf patients ont complété l'IB, I'IRVL et l'EDZ avec des moyennes respectives de 99 ± 2 pour l'IB, 89 ± 14 pour l'IRVL et 33 ±11 pour l'EDZ, ce qui est compatible avec des déficits fonctionnels et de l'humeur qui sont minimes.

Conclusions:

L'embolisation endovasculaire par spires chez les patients porteurs d'une HSA de haut grade est sure. Bien que la morbidité et la mortalité dues à l'HSA de haut grade demeurent importantes, des résultats radiologiques et fonctionnels favorables peuvent être obtenus chez une grande proportion de ces patients dont l'état est critique.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 30 - 35
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

References

1. Nieuwkamp, DJ, Setz, LE, Algra, A, Linn, FH, de Rooij, NK, Rinkel, GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8:635–42.CrossRefGoogle ScholarPubMed
2. Hunt, WE, Hess, RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28: 14–20. Google Scholar
3. Wilby, MJ, Sharp, M, Whitfield, PC, Hutchinson, PJ, Menon, DK, Kirkpatrick, PJ. Cost-effective outcome for treating poor-grade subarachnoid hemorrhage. Stroke. 2003;34:2508–11.Google Scholar
4. Fisher, CM, Kistler, JP, Davis, JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning, Neurosurgery. 1980;6:1–9.CrossRefGoogle ScholarPubMed
5. Banks, JL. Marotta, CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38:1091–6.CrossRefGoogle ScholarPubMed
6. Mahoney, FI, Barthel, DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–5.Google ScholarPubMed
7. Wood-Dauphinee, SL, Opzoomer, MA, Williams, JI, Marchand, B, Spitzer, WO. Assessment of global function: the Reintegration to Normal Living Index. Arch Phys Med Rehabil. 1988;69:583–90.Google Scholar
8. Wood-Dauphinee, S, Williams, JI. Reintegration to Normal Living as a proxy to quality of life. J Chronic Dis 1987;40:491–502.Google Scholar
9. Zung, WW, A Self-rating depression scale. Arch Gen Psychiatry, 1965;12:63–70.Google Scholar
10. Le Roux, PD, Elliott, JP, Newell, DW, Grady, MS, Wimi, MR. Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg, 1996;85:39–49.Google Scholar
11. Teasdale, GM, Drake, CG, Hunt, W. et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry. 1988;51:1457.Google Scholar
12. Kassell, NF, Tomer, JC, Jane, JA, Haley, EC. Jr. Adams, HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: surgical results. J Neurosurg. 1990;73:37–47.Google Scholar
13. Hutchinson, PJ, Power, DM, Triputhi, P, Kirkpatrick, PJ. Outcome from poor grade aneurysmal subarachnoid haemorrhage--which poor grade subarachnoid haemorrhage patients benefit from aneurysm clipping? Br J Neurosurg, 2000;14:105–9.Google Scholar
14. van Loon, J, Waerzeggers, Y, Wilms, G, Van Calenbergh, F, Goffin, J, Plets, C. Early endovaseular treatment or ruptured cerebral aneurysms in patients in very poor neurological condition. Neurosurgery. 2002;50:457-64; discussion 464-5.Google Scholar
15. Vinuela, F, Duckwiler, G, Mawad, M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg. 1997;86:475–82.Google Scholar
16. Hob, BL, Topcuoglu, MA, Siughal, AB. et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2004;55:779-86; discussion 786-9.Google Scholar
17. Rabinstein, AA, Pichelmann, MA, Friedman, JA. et al. Symptomatic vasospasm and outcomes following aneurysmal subarachnoid hemorrhage: a comparison between surgical repair and endovascular coil occlusion. J Neurosurg. 2003;98:319–25.CrossRefGoogle ScholarPubMed
18. Pereira, AR, Sanchez-Pena, P, Biondi, A. et al. Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage. Neurocrit Care. 2007;7:18–26.Google Scholar
19. Suzuki, S, Jahan, R, Duckwiler, GR, Frazee, J, Martin, N, Vinuela, F. Contribution of endovascular therapy to the management of poor-grade aneurysmal subarachnoid hemorrhage: Clinical and angiographic outcomes. J Neurosurg. 2006;105:664–70.Google Scholar
20. Weir, RU, Marcellus, ML, Do, HM, Steinberg, GK, Marks, MP. Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system. AJNR Am J Neuroradiol. 2003;24:585–90.Google Scholar
21. Bracard, S, Lebcdinsky, A, Anxionnat, R. et al. Endovascular treatment of Hunt and Hess grade IV and V aneuryms. AJNR Am J Neuroradiol. 2002;23:953–7.Google Scholar
22. Groden, C, Kremer, C, Regelsberger, J, Hansen, HC, Zeumer, H. Comparison of operative and endovascular treatment of anterior circulation aneurysms in patients in poor grades. Neuroradiology. 2001;43:778–83.Google Scholar
23. Byrne, JV. Long-term outcomes of Guglielmi detachable coil packing for acutely ruptured cerebral aneurysms. AJNR Am J Neuroradiol. 1999;20:1184.Google Scholar
24. Kremer, C, Groden, C, Hansen, HC, Grzyska, U, Zeumer, H. Outcome after endovascular treatment of Hunt and Hess grade IV or V aneurysms: comparison of anterior versus posterior circulation. Stroke. 1999;30:2617–22.Google Scholar
25. Malisch, TW, Guglielmi, G, Vinuela, F. et al. Intracranial aneurysms treated with the Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg. 1997; 87:176-83.Google Scholar
26. Casasco, AE, Aymard, A, Gobin, YP. et al. Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg. 1993;79:3–10.Google Scholar
27. Suzuki, M, Otawara, Y, Doi, M, Ogasawara, K, Ogawa, A. Neurological grades of patients with poor-grade subarachnoid hemorrhage improve after short-term pretreatment. Neurosurgery. 2000;47:1098–104; discussion 1104-5.Google Scholar
28. Rordorf, G, Ogilvy, CS, Gress, DR, Crowell, RM, Choi, IS. Patients in poor neurological condition after subarachnoid hemorrhage: early management and long-term outcome. Acta Neurochir (Wien). 1997;139:1143–51.Google Scholar
29. Steudel, WI, Reif, J, Voges, M. Modulated surgery in the management of ruptured intracranial aneurysm in poor grade patients. Neurol Res. 1994;16:49–53.Google Scholar
30. Hutter, BO, Kreitschmann-Andermahr, I, Gilsbach, JM. Healthrelated quality of life after aneurysmal subarachnoid hemorrhage: impacts of bleeding severity, computerized tomography findings, surgery, vasospasm, and neurological grade. J Neurosurg. 2001;94:241–51.CrossRefGoogle ScholarPubMed
31. Richardson, AE, Jane, JA, Payne, PM. The prediction of morbidity and mortality in anterior communicating aneurysms treated by proximal anterior cerebral ligation. J Neurosurg. 1966;25:280–3.CrossRefGoogle ScholarPubMed
32. Szydelko, M, Kwolek, A, Druzbicki, M. Results of rehabilitation in patients after subarachnoid haemorrhage from ruptured intracranial aneurysm and after surgical treatment. Neurol Neurochir Pol. 2008;42:116–22.Google Scholar
33. Clinchot, DM, Kaplan, P, Murray, DM, Pease, WS. Cerebral aneurysms and arteriovenous malformations: implications for rehabilitation. Arch Phys Med Rehabil. 1994;75:1342–51.Google Scholar
34. Mocco, J, Ransom, ER, Komotar, RJ. et al. Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage. J Neurol. 2006;253:1278–84.CrossRefGoogle ScholarPubMed