Key result
Clipping was significantly associated with a higher risk of intraoperative rebleeding at the anterior communicating artery compared to coiling (OR 4.00; 95% CI 1.82-8.80; p < 0.001).
Why the study?
Aneurysm rebleeding causes major morbidity and mortality in aneurysmal subarachnoid hemorrhage, and identifying predictors across preoperative, intraoperative, and postoperative periods may help guide acute management.
Cohort (n=4,933)
Odds Ratio: 4 (95% CI 1.82–8.8)
p-value: p=<0.001
Aneurysm rebleeding after SAH occurs at different rates across perioperative periods, with specific risk factors such as clipping at the anterior communicating artery significantly increasing intraoperative rebleeding risk.
Clipping at the anterior communicating artery may heighten intraoperative rebleeding risk; leaves open optimal technique selection in aneurysmal SAH.
OBJECTIVE: Aneurysm rebleeding is a major cause of death and morbidity in patients with aneurysmal subarachnoid hemorrhage (SAH). Recognizing the predictors of rebleeding might help to identify patients who will benefit from acute management. This study was performed to investigate the predictors of aneurysm rebleeding and their impact on clinical outcomes in the preoperative, intraoperative, and postoperative periods. METHODS: The incidence of rebleeding, demographic data, and clinical data from 4933 patients with aneurysmal SAH beginning in the year 2000 were retrospectively analyzed in the Nagasaki SAH Registry Study. The authors performed multiple logistic regression analyses to identify the risk factors contributing to rebleeding and outcome after SAH. RESULTS: Preoperative rebleeding occurred in 7.2% of patients. Patient age (p = 0.01), multiple aneurysms (p < 0.01), aneurysm size (p < 0.0001), and heart disease (p = 0.03) were significantly associated with preoperative rebleeding. Conversely, intraoperative rebleeding occurred in 11.2% of patients. Aneurysm location (anterior communicating artery [ACoA]), family history (p = 0.02), preoperative rebleeding (p < 0.01), and clipping/coiling (p < 0.0001) were significantly associated with intraoperative rebleeding. Interaction analysis showed that clipping significantly affected intraoperative rebleeding at the ACoA (OR 4.00; 95% CI 1.82-8.80; p < 0.001). Postoperative rebleeding occurred in 2.4% of patients. Coiling/clipping (p < 0.0001) and intraoperative rebleeding (p < 0.01) were significantly associated with postoperative rebleeding. Rebleeding in all time periods examined significantly contributed to the clinical outcome after SAH. CONCLUSIONS: Aneurysm rebleeding after SAH has specific characteristics in the preoperative, intraoperative, and postoperative periods, and all of these characteristics contribute to the clinical outcome. The ACoA has a higher risk of intraoperative rebleeding, and endovascular coiling could be a good candidate in terms of techniques for preventing intraoperative rebleeding, although complete aneurysm obliteration should be accomplished.
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Horie et al. (2019) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=4,933). Clipping vs. Coiling was evaluated on Intraoperative rebleeding at the anterior communicating artery (OR 4.00, 95% CI 1.82-8.80, p=<0.001). Clipping was significantly associated with a higher risk of intraoperative rebleeding at the anterior communicating artery compared to coiling (OR 4.00; 95% CI 1.82-8.80; p < 0.001).
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