Clinical neurology and neurosurgery · 2026
Association between treatment modality and delayed cerebral ischemia in 2748 patients with aneurysmal subarachnoid hemorrhage: A 12-year single center experience.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Tian Zichuan, Li Tu, Liu Yanan, Lau Tzak Ying, Huang Jian, Chen Xiaolin
Аннотация
BACKGROUND: Delayed cerebral ischemia (DCI) is a severe postoperative complication of aneurysmal subarachnoid hemorrhage (aSAH). Appropriate selection of the optimal surgical modality plays a critical role. It was widely known that two landmark clinical trials, International Subarachnoid Aneurysm Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT), have compared the efficacy of two major treatments for patient with aSAH. However, we still need a large-scale observational study to prove the association between treatment modality and DCI risk. Thus, we intended to validate the impact of treatment modality on DCI and short-term functional outcome.
METHODS: A total of 2748 patients were previously admitted to Beijing Tiantan hospital in China from January 2012 to December 2023. The primary outcome was DCI. The functional outcome at 3-month was evaluated by modified Rankin Scale (mRS). A propensity score matching (PSM) was used to balance the differences between microsurgical treatment and endovascular treatment, respectively. Multivariate analysis before and after PSM were performed to evaluating the potential risk factors associated with DCI and 3-month mRS.
RESULTS: All the 2748 patients with a median age of 55 (48,63) were included, and 1616 (58.8%) were female. Multivariate adjusted analysis before PSM and after PSM demonstrated that microsurgical treatment (OR 2.510, 95%CI 2.081-3.028, P < 0.001; OR 2.715, 95%CI 2.202-3.347, P < 0.001) was a risk factor independently associated with DCI. Over the past 12 years, this large-scale cohort study revealed an overall declining trend in the incidence of DCI for both treatment modality, during which the utilization rate of microsurgical treatment and the incidence of DCI demonstrated a largely parallel trend.
CONCLUSIONS: Microsurgical treatment, compared with endovascular treatment, is independently associated with the occurrence of DCI and poor functional outcome. In this 12-year cohort study, the incidence of DCI exhibited an overall decline alongside a parallel trend in microsurgical utilization. Concurrently, there was a marked increment in the adoption of endovascular strategy.
METHODS: A total of 2748 patients were previously admitted to Beijing Tiantan hospital in China from January 2012 to December 2023. The primary outcome was DCI. The functional outcome at 3-month was evaluated by modified Rankin Scale (mRS). A propensity score matching (PSM) was used to balance the differences between microsurgical treatment and endovascular treatment, respectively. Multivariate analysis before and after PSM were performed to evaluating the potential risk factors associated with DCI and 3-month mRS.
RESULTS: All the 2748 patients with a median age of 55 (48,63) were included, and 1616 (58.8%) were female. Multivariate adjusted analysis before PSM and after PSM demonstrated that microsurgical treatment (OR 2.510, 95%CI 2.081-3.028, P < 0.001; OR 2.715, 95%CI 2.202-3.347, P < 0.001) was a risk factor independently associated with DCI. Over the past 12 years, this large-scale cohort study revealed an overall declining trend in the incidence of DCI for both treatment modality, during which the utilization rate of microsurgical treatment and the incidence of DCI demonstrated a largely parallel trend.
CONCLUSIONS: Microsurgical treatment, compared with endovascular treatment, is independently associated with the occurrence of DCI and poor functional outcome. In this 12-year cohort study, the incidence of DCI exhibited an overall decline alongside a parallel trend in microsurgical utilization. Concurrently, there was a marked increment in the adoption of endovascular strategy.