Introduction: : The timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage (aSAH) was a subject of controversy. Most vascular neurosurgeons agreed on early aneurysm treatment (within the first 72 hours). However, though practiced in some neurosurgical centers, whether ultra-early aneurysm treatment (within the first 24 hours) was beneficial remained debatable. We aimed to investigate whether ultra-early aneurysm treatment is associated with better outcome.

Methods: Two-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. P-values less than 0.05 were taken as statistically significant and P-values between 0.05 and 0.10 were considered to be a trend.

Results: Ultra-early aneurysm treatment was associated with significantly better neurological outcome in mRS (mRS 0-1: OR 1.9 [95%CI 1.1 to 3.4], p=0.020), adjusted for age and admission WFNS grade. A reduction in clinical rebleeding was observed in poor grade patients undergoing ultra-early aneurysm treatment (9% vs 18%, p=0.159).

Conclusions: Aneurysm treatment performed within the 24-hour window may be associated with better outcome and halved the clinical rebleeding risk in poor grade patients.

Patient Care: The benefit of ultra-early aneurysm treatment should induce adequate resource allocation for provision of expert aneurysm treatment (embolization and clipping) in all neurosurgical centers.

Learning Objectives: Aneurysm treatment as soon as feasible is beneficial to aneurysmal subarachnoid hemorrhage.

References: Ultra-Early (within 24 Hours) Aneurysm Treatment After Subarachnoid Hemorrhage. Wong GK, Boet R, Ng SC, Chan M, Gin T, Zee B, Poon WS. World Neurosurg. 2011 Nov 1. [Epub ahead of print]