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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
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Abstract:

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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

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