Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry.

Maduri, Rodolfo; Starnoni, Daniele; Rocca, Alda; Bervini, David; Zumofen, Daniel Walter; Stienen, Martin Nikolaus; Schatlo, Bawarjan; Fung, Christian; Robert, Thomas; Seule, Martin A; Burkhardt, Jan-Karl; Maldaner, Nicolai; Rothlisberger, Michel; Blackham, Kristine A; Marbacher, Serge; D'Alonzo, Donato; Remonda, Luca; Machi, Paolo; Gralla, Jan; Bijlenga, Philippe; ... (2019). Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry. Acta neurochirurgica, 161(4), pp. 769-779. Springer Vienna 10.1007/s00701-019-03812-9

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BACKGROUND The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques. OBJECTIVE To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes. METHODS This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined. RESULTS From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year. CONCLUSIONS In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Bervini, David and Gralla, Jan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0001-6268

Publisher:

Springer Vienna

Language:

English

Submitter:

Nicole Söll

Date Deposited:

08 Mar 2019 14:50

Last Modified:

21 May 2019 14:33

Publisher DOI:

10.1007/s00701-019-03812-9

Related URLs:

PubMed ID:

30680461

Uncontrolled Keywords:

Aneurysmal subarachnoid hemorrhage Endovascular procedures Hydrocephalus Intracranial aneurysms Intracranial vasospasm Posterior circulation Ruptured aneurysms

BORIS DOI:

10.7892/boris.125832

URI:

https://boris.unibe.ch/id/eprint/125832

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