The effects of ultra-early clipping on survival and neurological outcome in poor-grade aneurysmal subarachnoid haemorrhage

Background and purpose: European Stroke Organisation guidelines advise treating aneurysmal subarachnoid haemorrhage (aSAH) as early as possible. However, the optimum timing along with its beneficial effects is controversial. Therefore, we aimed to investigate the effects of ultra-early clipping on neurological outcomes and survival in poor-grade aneurysmal subarachnoid haemorrhages. Methods: This retrospective study included all poor-grade aneurysmal subarachnoid haemorrhage patients treated by ultra-early surgical clipping at Trakya University Hospital between January 1, 2001, and December 31, 2020. We analysed the outcome and mortality data of these patients. Specifically, we evaluated the effects of ultra-early clipping on outcomes, defined as within six hours of the onset of symptoms. Results: From 813 records, 212 met our inclusion criteria. Of these, 117 (55.2%) were female and 95 (44.8%) male. The mean age was 58.3 ± 13.7 years. Glasgow Outcome Scale scores differed significantly between age groups, subarachnoid haemorrhage grades, those who did and did not rebleed, and those who did or did not suffer from vasospasms. A beneficiary relationship was found between ultra-early clipping and mortality among patients. Furthermore, favourable outcomes were significantly more frequent in the ultra-early clipping group. Conclusion: The aSAH patients treated at our hospital who received ultra-early clipping had significantly lower mortality rates and more favourable outcomes. The difference was significant among those treated during the last decade and among patients younger than 50.