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  • Improving Outcomes in Poor Grade Subarachnoid Hemorrhage (SAH) Patients: Implications of Changing Practice Patterns at a High Volume Cerebrovascular Center

    Final Number:
    100

    Authors:
    Kadir Erkmen MD; Aditya Sanzgiri; Mark J. Dannenbaum MD; Arthur L. Day MD; Peng Roc Chen MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Poor grade SAH patients (Hunt & Hess 4/5) are considered to have low likelihood of good outcomes. Endovascular treatment has demonstrated improved outcomes in patients with SAH and has been used increasingly over time. We hypothesized that the increase in use of endovascular techniques may contribute to overall improved outcomes in poor-grade patients.

    Methods: Poor-grade SAH Patients treated at a single cerebrovascular center were evaluated in a retrospective consecutive cohort study. Modality of treatment was decided at the discretion of treating physicians. Cohort A included consecutive patients treated between 2005-2007; cohort B included consecutive patients treated between 2008-2012. Patient outcomes were measured using modified Rankin scores (mRs) and compared between the cohorts. Good outcome was defined as mRs 0-2.

    Results: Cohort A demonstrated good outcomes at discharge and 6 months follow-up in 1/59 (1.7%) and 9/41 (21.9%) patients respectively, with 28/59 (47.5%) patients treated with endovascular techniques. Cohort B demonstrated good outcomes at discharge and 6 months in 24/71 (33.8%) and 27/61 (42.9%) patients respectively, with 55/71 (77.5%) receiving endovascular repair. Both cohorts exhibited similar patient demographics and distribution of HH 4 and 5 patients. However, the percentage of good outcomes at discharge and 6 months was significantly higher in cohort B (p<0.001 and p=0.029). Similarly, the percentage of patients treated with endovascular techniques was significantly higher in Cohort B (p=0.004).

    Conclusions: We demonstrate improving outcomes in poor grade SAH patients over time in this single center, with good outcome observed in 42.9% of contemporary patients. Improved outcomes were paralleled by an evolution of practice pattern with a significant increase in the percentage of patients treated with endovascular techniques. Technological improvements and advancing endovascular techniques likely account for the increase in endovascular treatment utilized over time. Observed improvement in outcomes may be related to the higher percentage of patients treated with endovascular techniques.

    Patient Care: The study describes improving outcomes in poor-grade SAH patents over time in a single center. who previously have been considered to have low likelihood of good outcome.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) identify the likelihood of good outcome in poor grade SAH patients, 2) understand that outcomes are improving over time, 3) identify increased use of endovascular repair of aneurysms as a potential factor accounting for improving outcomes over time.

    References:

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