Title: Correlation of Ruptured Aneurysm Size at Subarachnoid Hemorrhage with Clinical Characteristics and Outcome
Abstract: Aim: Ruptured aneurysms are believed to be usually larger than unruptured aneurysms. Therefore, aneurysm size (7-mm border) has remained an important factor to guide treatment recommendation in incidental aneurysms. The aim of this study was to assess the impact of the size of ruptured intracranial aneurysms in patients with subarachnoid hemorrhage (SAH) on clinical status at admission, treatment modality, and clinical outcome. Methods: We analyzed the data from our single-center SAH database between 2009 and 2013 at the Kantonsspital Aarau. Aneurysm size at rupture, measured at maximal diameter in digital subtraction angiograms (DSA), was recorded and divided in two groups: aneurysms < 7 mm (N = 70, group 1) and ≥ 7 mm (N = 52, group 2). Statistical correlation of the size was assessed between the clinical presentation at hospital admission (age, gender, focal neurological deficits [FND], Glasgow Coma Score [GCS], Fisher score), treating modality (clip, coil), and clinical outcome at discharge measured with modified Rankin scale (mRS). Results: Our study included 122 patients with aneurysmal SAH (aSAH). The mean age was 53 years (17–85 years); 48 (39%) were male and 74 (61%) female. A total of 70 (57%) aneurysms were <7 mm diameter (group 1) and 52 (43%) were ≥7 mm (group 2). The median diameter was 6 mm. FND were recorded in 30% of the group 1 and in 29% of the group 2 cohort. The GCS at admission was dichotomized (GCS 3–8, GCS 9–12, GCS 13–15) and there was no statistical difference between the GCS subgroups (p = 0.232). Over two-thirds of all the patients presented a Fischer score of 3 or 4 with no difference between the single scores (0–4; p = 0.156). Smaller aneurysms were preferred for surgical clipping compared with aneurysms > 7 mm (31% group 1 vs. 20% group 2). The mRS at discharge was dichotomized in two subgroups (0–2 and 3–6); there was no difference regarding the aneurysm diameter (p = 0.102). Conclusions: Our observational study demonstrates that the majority of ruptured aneurysms leading to aSAH are smaller than 7 mm in diameter. Smaller aneurysms show a tendency to have a better clinical outcome at discharge. Although we cannot extrapolate the risk from retrospective analysis of ruptured aneurysms to unruptured aneurysms, this study obviates the need of further prospective investigations to minimize the rupture risks in patients harboring incidental aneurysms <7 mm in the Swiss population. In a next step, data from the Swiss SOS database will be analyzed for this purpose.
Publication Year: 2015
Publication Date: 2015-09-07
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 1
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