Treatment of aneurysmal subarachnoid hemorrhage in subacute phase; retrospective comparison of treatment in sub- and hyper-acute phases

Kurisu, Kota; Hokari, Masaaki; Uchida, Kazuki; Asaoka, Katsuyuki; Ajiki, Minoru; Takada, Tatsuro; Itamoto, Koji; Fujimura, Miki

Treatment of aneurysmal subarachnoid hemorrhage in subacute phase; retrospective comparison of treatment in sub- and hyper-acute phases

Kurisu, Kota; Hokari, Masaaki; Uchida, Kazuki et al.

Clinical neurology and neurosurgery, 2023, 230, 107781

Permalink : https://hdl.handle.net/2115/93063

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アクセス権	open access
URI	https://hdl.handle.net/2115/93063
タイトル	Treatment of aneurysmal subarachnoid hemorrhage in subacute phase; retrospective comparison of treatment in sub- and hyper-acute phases
著者	Kurisu, Kota ; Hokari, Masaaki ; Uchida, Kazuki ; Asaoka, Katsuyuki ; Ajiki, Minoru ; Takada, Tatsuro ; Itamoto, Koji ; Fujimura, Miki
e-Rad_Researcher 30869839 著者名 Kurisu, Kota
著者名 Hokari, Masaaki
著者名 Uchida, Kazuki
著者名 Asaoka, Katsuyuki
著者名 Ajiki, Minoru
著者名 Takada, Tatsuro
著者名 Itamoto, Koji
e-Rad_Researcher 00361098 著者名 Fujimura, Miki
言語	英語
キーワード	Subarachnoid hemorrhage
	Subacute
	Cerebral aneurysm
	Vasospasm
	Clipping
	Coiling
発行日	2023-07
出版者	Elsevier
収録物名	Clinical neurology and neurosurgery
巻(号)	230
ページ	107781
抄録	Objective: As soon as possible treatment initiation for aneurysmal subarachnoid hemorrhage (aSAH) is recom-mended. However, some patients require treatment in "subacute" phase of aSAH, defined in this study as "more than one day after the onset". To establish an optimal treatment strategy for these patients, we retrospectively analyzed the clinical experience of treating ruptured aneurysm with either clipping or coiling in subacute phase.Methods: Patients treated for aSAH between 2015 and 2021were analyzed. Patients were divided into the hy-peracute phase (within 24 h) and subacute phase (later than 24 h) groups. The subacute group was analyzed to determine whether the selected procedure and its timing affected postoperative course and clinical outcomes. In addition, we conducted a multivariate logistic regression analysis to determine the independent factors that affect clinical outcomes.Results: Of 215 patients, 31 were treated in the subacute phase. While cerebral vasospasm at initial imaging was more frequently observed in subacute group, there was no difference in incidence of postoperative vasospasms. Patients in subacute group seemed to have better clinical outcomes due to the milder severity at the time of treatment initiation. Risk of angiographic vasospasm seemed to be higher in patients treated with clipping than coiling, while no difference was seen in clinical outcomes. Multivariate logistic regression analysis showed that the timing and selected treatment did not significantly affect the clinical outcome or the occurrence of delayed vasospasm.Conclusions: Treatment of aSAH in the subacute phase may also result in favorable clinical outcomes, similar to patients treated in the hyperacute phase with mild presentation. However, further investigations are required to establish the optimal treatment strategies for such patients.
資源タイプ	学術雑誌論文
出版タイプ	Accepted Manuscript
権利情報	Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
権利情報	© 2023. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
PISSN	0303-8467
関連情報 (isVersionOf)	出版社版DOI https://doi.org/10.1016/j.clineuro.2023.107781