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Outcomes following failed primary treatment following aneurysmal subarachnoid haemorrhage
Author(s): ,
W. Sage
Affiliations:
Nottingham University Hospitals, Neurosurgery, Nottingham, United Kingdom
,
P. Copley
Affiliations:
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Neurosurgery, Cambridge, United Kingdom
,
M. Sethi
Affiliations:
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Neurosurgery, Cambridge, United Kingdom
,
M. Guilfoyle
Affiliations:
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Neurosurgery, Cambridge, United Kingdom
,
P. Kirkpatrick
Affiliations:
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Neurosurgery, Cambridge, United Kingdom
,
R. Kirollos
Affiliations:
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Neurosurgery, Cambridge, United Kingdom
R. Trivedi
Affiliations:
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Neurosurgery, Cambridge, United Kingdom
EANS Academy. Sage W. Oct 21, 2018; 226105; EP1088
William Sage
William Sage
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Abstract
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Objectives:
To examine outcomes in patients with aneurysmal subarachnoid haemorrhage (SAH) where primary treatment was unsuccessful.

Design:
A single centre, retrospective case note and radiological review of all patients from 01/01/2011 to 01/05/2015.

Subjects:
423 patients who presented to our centre with an aneurysmal SAH. All grades and treatment methods were included.

Methods:
Imaging and notes were reviewed to establish the treatment type, complication rates and outcomes following SAH. Subjects were split into 4 treatment groups (Groups 1,2,3,4: coiled, clipped, failed coiling to clipping and failed clipping to coiling respectively). Data was analysed using STATA. The primary endpoint was favourable or unfavourable modified rankin scale (MRS) at 3 months.

Results:
There were 193, 206, 22 and 2 patients in the 4 treatment groups. Baseline characteristics of each group except aneurysm location (p=0.000). There was no statistical difference in complication rate between the groups.

Logistic regression showed no significant difference in favourable and unfavourable outcome between the treatment groups, including those failed primary treatment. Factors predictive of outcome were poor WFNS grade, re-bleed either pre or post procedure, radiological evidence of vasospasm and infarct and hydrocephalus.

Conclusions:
Treatment decisions for aneurysmal SAH are dependent on a number of patient and aneurysm characteristics. A favourable outcome can still be achieved despite failure of initial treatment.
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