Early occlusion key to preventing aneurysmal subarachnoid haemorrhage rebleeding

By Lucy Piper, Senior medwireNews Reporter

Researchers stress the need for early occlusion of subarachnoid aneurysms to prevent death from rebleeding.

The team compared the outcomes of 844 patients who had aneurysmal subarachnoid haemorrhages (aSAHs) in 1999–2000 and 2009–2012 and were treated at the same institution; between these time periods the 90-day fatality rate fell from 39% of 381 patients to 30% of 463 patients.

There was also a significant 53% reduction in the risk of dying from rebleeding among patients in the later versus the earlier time period. The initial bleed remained the most common cause of death at both time points, however.

Mervyn Vergouwen (University Medical Center Utrecht, the Netherlands) and team note in Neurology that there was a shift in the median day of aneurysm occlusion, from day 4 in 1999–2000 to day 1 in 2009–2012.

And they suggest that this may explain the decline in in-hospital rebleeding, which fell from 24% in 1999–2000 to 17% in 2009–2012, at a significant risk ratio of 0.68, as well as the decline in the overall 90-day fatality rate.

“First, median day of aneurysm treatment was 3 days later in the first compared with the second time period. Second, median day of rebleeding was 5 days later in the first time period”, Vergouwen and team report.

The researchers also point out that in-hospital death from rebleeding happened later in the first period, on day 6 compared with day 1 in the second time period.

After taking into account the timing of aneurysm occlusion, there was no longer a significant difference in death rates between the two time periods, which the team says “further strengthens the conclusion that timing of aneurysm treatment is an important determinant of outcome after aneurysmal SAH.”

Vergouwen and colleagues explain that fewer patients in the earlier time period received aneurysm treatment, at 251 (66%) versus 350 (75%), because they rebled before their scheduled treatment and therefore did not undergo occlusion. This explains the counter-intuitive finding of day 5 as the median for rebleeding and day 4 for aneurysm treatment, they say.

“Our results have important implications for clinical practice and future research,” the researchers conclude. “Our data stress the need for early occlusion of the aneurysm and the need for other strategies to improve outcome by reducing the risk of rebleeding.”

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