Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Differential impact of treatment timing on clinical outcomes after endovascular management of ruptured intracranial aneurysms across circulation locations.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Ortega-Moreno Diego A, López-Soto Ricardo, Ku Jerry C, Almulhim Ibrahim, Chan Vanessa, Cancelliere Nicole, Diestro Jose Danilo B, Marotta Tom, Spears Julian, Dmytriw Adam A, Pereira Vitor Mendes
Аннотация
OBJECTIVE: To evaluate the interaction between treatment timing (≤24 h vs. > 24 h) and circulation distribution (anterior vs. posterior) on functional recovery after aneurysmal subarachnoid hemorrhage (aSAH).
METHODS: We conducted a retrospective single-center cohort study of 240 patients with ruptured intracranial aneurysms treated endovascularly between 2019 and 2024. Aneurysms were classified by circulation, and timing of intervention was dichotomized. Primary outcome was change in modified Rankin Scale (mRS) at 6 and 12 months.
RESULTS: The mean age was 56.69 ± 13.95 years, with 181/240 patients (75.4%) being female. Posterior circulation aneurysms were associated with higher odds of hydrocephalus (p = 0.001) and prolonged hospitalization (p = 0.04). When evaluating mRS change, anterior circulation aneurysms showed improvement regardless of timing, with comparable reductions in mean mRS between early and delayed treatment groups (ΔmRS -2.21 vs. -2.13). In contrast, posterior circulation aneurysms demonstrated greater improvement with early intervention, whereas delayed treatment was associated with more limited recovery (ΔmRS -2.0 vs. -0.88). These differences were derived from within-group comparisons; in adjusted analyses, treatment timing was not independently associated with functional independence at 6 or 12 months.
CONCLUSIONS: Distinct recovery trajectories following aSAH may be influenced by aneurysm location and its interaction with treatment timing. Although not independently confirmed after adjustment, the observed patterns support a potential role for anatomical factors in shaping functional recovery and warrant further evaluation in larger studies to clarify their implications for treatment prioritization.
METHODS: We conducted a retrospective single-center cohort study of 240 patients with ruptured intracranial aneurysms treated endovascularly between 2019 and 2024. Aneurysms were classified by circulation, and timing of intervention was dichotomized. Primary outcome was change in modified Rankin Scale (mRS) at 6 and 12 months.
RESULTS: The mean age was 56.69 ± 13.95 years, with 181/240 patients (75.4%) being female. Posterior circulation aneurysms were associated with higher odds of hydrocephalus (p = 0.001) and prolonged hospitalization (p = 0.04). When evaluating mRS change, anterior circulation aneurysms showed improvement regardless of timing, with comparable reductions in mean mRS between early and delayed treatment groups (ΔmRS -2.21 vs. -2.13). In contrast, posterior circulation aneurysms demonstrated greater improvement with early intervention, whereas delayed treatment was associated with more limited recovery (ΔmRS -2.0 vs. -0.88). These differences were derived from within-group comparisons; in adjusted analyses, treatment timing was not independently associated with functional independence at 6 or 12 months.
CONCLUSIONS: Distinct recovery trajectories following aSAH may be influenced by aneurysm location and its interaction with treatment timing. Although not independently confirmed after adjustment, the observed patterns support a potential role for anatomical factors in shaping functional recovery and warrant further evaluation in larger studies to clarify their implications for treatment prioritization.