Early Complications and Outcome After Treatment of Ruptured Aneurysms in Patients with Subarachnoid Hemorrhage–A Post Hoc Analysis of the EARLYDRAIN Trial

Aneurysmal subarachnoid hemorrhage (aSAH) from a ruptured intracranial aneurysm is a severe, life-threatening condition with high morbidity and mortality. The current treatment often involves surgical clipping or endovascular treatment within the first 24-48 hours. While there is ample evidence on complications of treating unruptured aneurysms, smiliar data in patients with acutly ruptured aneurysms is limited. The Earlydrain trial showed improved neurological results from lumbar-drainage after aneurysm treatment in patients with aSAH. Using this dataset, we aim to study frequency and effects of complications and identify associated risk factors. This is a sub-study of the prospective multicenter randomized controlled Earlydrain trial. We analyzed treatment associated complications (bleeding and/or infarctions) detected on a CT-scan on day 1 after aneurysm occlusion. Outcomes were the occurrence of postprocedural-complications, secondary infarctions in the acute phase and the modified-Ranking-Scale after 6 months. The Earlydrain-trial recruited 287 patients in 19 centers. 56 (19.5%) of these suffered from a treatment complication. 25(8.7%) patients experienced postprocedural intracranial hemorrhage and 34(11.8%) patients suffered from a treatment associated infarction. Patients suffering from a complication show more secondary infarctions(p=0.049) and worse neurological outcome after 180 days (p=0.025) compared to patients with no complication. Aneurysm location, rebleeding before the treatment, number of patients recruited per center and the day of the treatment were independent risk factors for the occurrence of complications. The present study reveals that patients with aSAH frequently experience intervention associated complications associated with aneurysm occlusion required to prevent recurrent hemorrhage. Consequently, aSAH patients with treatment related complications fare more often a worse clinical course and poor outcome.