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Perprocedural aneurysm rerupture in relation to timing of endovascular treatment and outcome
  1. Jasper Hans van Lieshout1,
  2. Dagmar Verbaan2,
  3. Rogier Donders3,
  4. Rene van den Berg4,
  5. Peter W P Vandertop2,
  6. Catharina J M Klijn5,
  7. Hans-Jakob Steiger1,
  8. Joost de Vries6,
  9. Ronald H M A Bartels5,
  10. Kerim Beseoglu1,
  11. Hieronymus D Boogaarts5
  1. 1Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
  2. 2Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
  3. 3Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
  4. 4Department of Neuroradiology, Academic Medical Center, Amsterdam, The Netherlands
  5. 5Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
  6. 6Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Jasper Hans van Lieshout, Department of Neurosurgery, Heinrich-Heine-University Düsseldorf, Düsseldorf, 40225, Germany; jh.vanlieshout{at}gmail.com

https://doi.org/10.1136/jnnp-2018-318090

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    Introduction

    The main aim in treatment of aneurysmal subarachnoid haemorrhage (aSAH) is prevention of rebleeding because rebleeding carries a high risk of poor outcome including death. Some studies have advocated ultra-early treatment (<24 hours) of ruptured aneurysms in order to reduce rebleeding and improve clinical outcome.1 The benefit of ultra-early treatment may be more pronounced for coiling than for surgical clipping.1 However, results have been inconsistent and it remains unclear whether ultra-early endovascular treatment improves clinical outcome in patients with aSAH in comparison with treatment within 24–72 hours.2 In a recent meta-analysis, comparison of the outcome after treatment within 24 hours and between 24 and 72 hours showed no clinical benefit of early treatment.2 One study suggested that ultra-early treatment exposes patients to harm.2 A potential risk of aneurysm obliteration within the first hours after rupture is a higher chance of perprocedural aneurysm rupture. We evaluated whether in patients with aSAH, timing of endovascular aneurysm repair is a risk factor for perprocedural aneurysm rupture and whether perprocedural aneurysm re-rupture has any clinical impact.

    Methods

    All consecutive patients with aSAH, treated by endovascular coil embolisation at the Radboud University Medical Centre (Nijmegen) and the Academic Medical Centre (Amsterdam) between January 2012 and January 2016, were included. From a prospectively collected database, we retrieved patient characteristics (age and sex), clinical (World Federation of Neurological Surgeons (WFNS) grade) and radiological (Fisher grade, aneurysm …

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    Footnotes

    • Contributors JHvL: conception and design, acquisition of data, analysis and interpretation of data, drafting the article, critically revising the article, reviewed submitted version of manuscript, approved the final version of the manuscript. DV: conception and design, acquisition of data, critically revising the article, reviewed submitted version of manuscript and approved the final version of the manuscript. RD: statistical analysis, critically revising the article, reviewed submitted version of manuscript and approved the final version of the manuscript. RvdB, MPV, CJMK, H-JS, JdV and RHMAB: critically revising the article, reviewed submitted version of manuscript and approved the final version of the manuscript. KB, conception and design, critically revising the article, reviewed submitted version of manuscript and approved the final version of the manuscript. HDB, conception and design, analysis and interpretation of data, critically revising the article, reviewed submitted version of manuscript, approved the final version of the manuscript and study supervision.

    • Funding One of the authors (CJMK) is supported by a clinical established investigator grant of the Dutch Heart Foundation (grant number 2012 T077), and an Aspasia grant from The Netherlands Organisation for Health Research and Development (ZonMw grant 015.008.048). Two authors (HDB and JdV) are consultants for Stryker Neurovascular.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The Institutional Boards of the Academic Medical Center and Radboud University Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.