Contribution of endovascular therapy to the management of poor-grade aneurysmal subarachnoid hemorrhage: clinical and angiographic outcomes

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  • 1 Division of Interventional Neuroradiology, Department of Radiological Sciences; and Division of Neurosurgery, University of California at Los Angeles, California
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Object

Treatment of patients presenting with poor-grade (Hunt and Hess Grade IV or V) subarachnoid hemorrhage (SAH) is controversial. Endovascular coil embolization has been considered a valuable therapeutic alternative to surgical clip placement for this kind of patient. The aim of the present study was to evaluate immediate and long-term angiographic and clinical outcomes in patients with poor-grade SAH treated by endovascular embolization.

Methods

One hundred eleven patients with Hunt and Hess Grade IV or V SAH were treated with endovascular embolization at the University of California at Los Angeles Medical Center between October 1990 and December 2004. Eighty patients harbored Grade IV hemorrhages and 31 patients had Grade V ones. Immediate and long-term anatomical and clinical outcomes were evaluated in all patients. Long-term clinical outcome assessments were based on follow-up data obtained over an average of 32 months posttherapy.

Technical complications occurred in 15 patients (13.5%). Immediate complete aneurysm occlusion was observed in 51.4% of aneurysms. Angiographic, long-term follow-up review revealed aneurysm recanalization in 16.2% of cases. Thirty-nine patients (35.1%) demonstrated a favorable long-term clinical outcome. The overall mortality rate in this patient series was 32.4%. The mortality rate associated with vasospasm was significantly higher in patients with Grade IV SAHs than in those with Grade V hemorrhages.

Conclusions

The results of this study demonstrate a valuable contribution of endovascular therapy of ruptured intracranial aneurysms in patients with Hunt and Hess Grade IV or V SAH. This technique was successful in decreasing repeated aneurysm rupture and in enabling aggressive medical management during the acute phase of SAH. This is particularly important in patients with Grade IV SAH because of their potential for obtaining higher physical and functional recoveries.

Abbreviations used in this paper:GDC = Guglielmi detachable coil; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; ISAT = International Subarachnoid Aneurysm Trial; mRS = modified Rankin Scale; NICU = neurological intensive care unit; SAH = subarachnoid hemorrhage; UCLA = University of California at Los Angeles; WFNS = World Federation of Neurological Societies.

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Contributor Notes

Address reprint requests to: Shuichi Suzuki, M.D., Ph.D., Division of Interventional Neuroradiology, Department of Radiological Sciences, 10833 LeConte Avenue, Box 951721, Los Angeles, California 90095-1721. email: ssuzuki@mednet.ucla.edu.
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