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Risk factors of short-term poor functional outcomes and long-term durability of ruptured large or giant intracranial

Hitoshi Fukuda1, Yuki Hyohdoh2, Kei Kawada3,4

  • 11Department of Neurosurgery, Kochi Medical School Hospital, Kochi.

Journal of Neurosurgery
|January 10, 2025
PubMed

Insights

Large aneurysmal subarachnoid hemorrhage (SAH) increases poor outcomes, especially in younger patients. While endovascular therapy offers better short-term results, direct surgery may reduce rebleeding risks.

Area of Science:

  • Neurosurgery
  • Neurology
  • Vascular Surgery

Background:

  • Aneurysmal subarachnoid hemorrhage (SAH) carries significant morbidity and mortality.
  • Large or giant intracranial aneurysms (≥ 10 mm) present unique challenges due to higher complication rates and poorer functional outcomes.
  • Limited data exists on specific risk factors for poor outcomes and long-term durability in ruptured large/giant aneurysms.

Purpose of the Study:

  • To identify specific risk factors for poor short-term functional outcomes in patients with SAH from ruptured large/giant intracranial aneurysms.
  • To evaluate the long-term durability and rebleeding rates associated with different treatment modalities.
  • To clarify interactions between risk factors and treatment choices for large/giant aneurysms.

Main Methods:

  • Retrospective analysis of 416 patients with SAH from ruptured large/giant aneurysms from a Japanese multicenter repository.
  • Multivariable analyses to identify risk factors for poor functional outcomes (modified Rankin Scale score ≥ 3).
  • Propensity score-based analysis to compare outcomes between direct surgery and endovascular therapy; rebleeding rates evaluated via survival analysis.

Main Results:

  • Increasing aneurysm size was a significant risk factor for poor functional outcomes (OR 1.13).
  • Negative effects of aneurysm size were amplified in younger patients, those with good initial neurological grade, and those treated with direct surgery.
  • Endovascular therapy was associated with better short-term functional outcomes (OR 1.56), but showed a higher rebleeding rate (4.8%) at 1 year compared to direct surgery (0.0%).

Conclusions:

  • Aneurysm size is a critical risk factor for poor outcomes in large/giant aneurysm SAH, influenced by patient and treatment factors.
  • Endovascular therapy improves short-term outcomes but necessitates careful monitoring due to increased delayed rebleeding risk.
  • Direct surgery may offer better long-term durability regarding rebleeding for these complex aneurysms.
Abstract

Keywords:
direct surgeryendovascular neurosurgeryendovascular therapylarge aneurysmrebleedingsubarachnoid hemorrhagevascular disorders

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