Key result
Obliteration of aneurysms by surgical clipping or endovascular coiling was associated with a significantly lower risk of 12-month mortality compared to medical management alone in patients with aneurysmal subarachnoid hemorrhage (adjusted HR 0.451).
Cohort (n=651)
Yes
Hazard Ratio: 0.451 (95% CI 0.272–0.747)
Absolute Event Rate: 12.2% vs 30.2%
Aneurysmal rupture is the most common cause of spontaneous SAH in China, and low rates of aneurysm obliteration contribute to long-term mortality.
May inform SAH etiology priorities in China; extends Asian epidemiology but leaves open management optimization.
AIMS: To conduct a large-scale analysis on epidemiology, management, and outcomes of spontaneous subarachnoid hemorrhage (SAH), and to investigate the current situation of aneurysm obliteration in China. METHODS: A multicenter prospective cohort study involving 132 hospitals throughout China from September 2007 to August 2008 was conducted. A total of 651 patients with spontaneous SAH were evaluated. RESULTS: The most frequent type of SAH was aneurysmal SAH (77.4%), followed by uncommon causes (17.5%) and uncertain etiologies (5.1%). For aneurysmal SAH, the cumulative mortality at 28 days, 3 months, 6 months, and 12 months was 16.9%, 21.2%, 23.6%, and 24.6%, respectively. Obliteration of aneurysms, age, Hunt and Hess grade, and history of stroke affected the 12-month mortality. In multiple regression analysis, the region, type of hospital, patient's age, history of hypertension, and nonintraventricular hemorrhage impacted aneurysm obliteration. CONCLUSION: Aneurysmal rupture is the most common cause of spontaneous SAH in China. The percentage of aneurysm obliteration is still low in China that seems to contribute to long-term mortality. With continued training of specialists, proper allocation of healthcare resources, and establishment of stroke centers, the rate of securing aneurysms is expected to rise.
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Bian et al. (2012) conducted a cohort in Spontaneous subarachnoid hemorrhage (n=651). Obliteration of aneurysms (neurosurgical clipping or endovascular coiling) vs. Medical management (non-surgical treatment) was evaluated on 12-month mortality (adjusted HR 0.451, 95% CI 0.272-0.747). Obliteration of aneurysms by surgical clipping or endovascular coiling was associated with a significantly lower risk of 12-month mortality compared to medical management alone in patients with aneurysmal subarachnoid hemorrhage (adjusted HR 0.451).
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