Short and long-term outcome of aneurysmal subarachnoid hemorrhage patients

Objective: To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment. Methods: In this prospective observational study, mortality and poor outcome (modified Rankin Scale 3-6) were analyzed in 311 patients with aSAH at 3-month, 1-year, and 5-year follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed. Results: Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months, with an absolute difference of 15.8%, and at 1 year, with an absolute difference of 15.9%. In both groups, Number Needed to Treat was 6.3. Odds ratios (OR) were 0.36 [95%CI 0.18-0.74] for endovascular and 0.40 [95%CI 0.20-0.81] for neurosurgical treatment. Complications did not differ between the two procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR=0.67 [95%CI 0.54-0.84)]. Conclusions: Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.