Dissecting aneurysm in poor-grade subarachnoid hemorrhage

Area of Science:

• Neurosurgery
• Interventional Neurology
• Vascular Neurology

Background:

• Intracranial dissecting aneurysms (DAs) are rare and difficult to treat neurovascular lesions.
• Patients with poor-grade subarachnoid hemorrhage (pSAH) often experience poor clinical outcomes.
• Optimal treatment strategies and timing for DAs in pSAH remain unclear.

Purpose of the Study:

• To analyze clinical features and treatment outcomes of DAs in a national pSAH registry.
• To identify independent predictors of outcome in pSAH patients with DAs.
• To evaluate the impact of rebleeding on mortality and long-term disability.

Main Methods:

• Retrospective analysis of prospectively collected data from the POGASH registry (Jan 2015-June 2024).
• Included consecutive patients with poor-grade (WFNS grade IV-V) subarachnoid hemorrhage.
• Classified DAs using the Mizutani classification; assessed outcomes via modified Rankin Scale.

Main Results:

• Analyzed 60 DA patients from 693 pSAH cases; 54 received treatment (88.9% endovascular).
• Rebleeding occurred in 23.3% of DA patients, significantly higher than the overall cohort.
• Rebleeding independently predicted in-hospital mortality (aOR 7.4) and long-term disability (aOR 0.08); blister aneurysms predicted rebleeding (aOR 8).

Conclusions:

• DAs in pSAH present unique features and a high risk of ultra-early rebleeding.
• Ultra-early rebleeding significantly impacts clinical outcomes in this patient group.
• Immediate treatment for DAs in pSAH may offer potential benefits, requiring further study.