What Factors Determine Treatment Outcome in Aneurysmal Subarachnoid Hemorrhage in the Modern Era? A Post Hoc STASH Analysis.
Guilfoyle, Mathew R
Kirkpatrick, Peter J
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Teo, M., Guilfoyle, M. R., Turner, C., Kirkpatrick, P. J., & STASH Collaborators,. (2017). What Factors Determine Treatment Outcome in Aneurysmal Subarachnoid Hemorrhage in the Modern Era? A Post Hoc STASH Analysis.. World neurosurgery, 105 270-281. https://doi.org/10.1016/j.wneu.2017.05.005
INTRODUCTION: The management of aneurysmal SAH has changed dramatically in the last few decades with the publication of a few major studies including The International Cooperative Study on the Timing of Aneurysm Surgery Study, International Subarachnoid Aneurysm Trial (ISAT). The aim of this study is to analyse the outcome of patients with aSAH based on a contemporary series, identify the risk factors for poor outcome, and focusing on patients with good grades aSAH (to match the ISAT cohort). METHOD: Baseline demographic and outcome data (mRS) was available on the 803 patients recruited from the STASH (Simvastatin in aneurysmal subarachnoid haemorrhage) trial for post hoc analysis, using chi square test or two-sample t-test. Logistic regression analysis was performed to assess the risk factors for poor outcome at 6 months. Propensity matched analysis comparing coiling and clipping, and subgroup analysis of good grades patients (WFNS I-II) were also performed. RESULT: Logistic regression analysis showed that the treatment modality (i.e coiling or clipping) was not associated with poor outcome at 6 months (p=0.839). The risk factors associated with poor outcome at 6 months were poor admission WFNS grade (p<0.0001), Fisher grade on initial CT scan (p=0.013), and the development of delayed cerebral ischaemia (DCI) (p<0.0001). Subgroup analysis for good grades patients only showed 82% of patients post coiling, and 78% of patients post clipping were classed as good outcome at 6 months (p=0.181). CONCLUSION: In the current era of aSAH management, apart from patients' admission status, SAH blood load and the development of DCI, treatment modality with either coiling or clipping was not associated with poor outcome difference at 6 months.
STASH Collaborators, Humans, Intracranial Aneurysm, Subarachnoid Hemorrhage, Simvastatin, Anticholesteremic Agents, Angiography, Digital Subtraction, Treatment Outcome, Risk Factors, Regression Analysis, Tomography Scanners, X-Ray Computed, Age Factors, International Cooperation, Adolescent, Adult, Aged, Middle Aged, Outcome Assessment (Health Care), Female, Male, Young Adult, Endovascular Procedures
External DOI: https://doi.org/10.1016/j.wneu.2017.05.005
This record's URL: https://www.repository.cam.ac.uk/handle/1810/265866