gms | German Medical Science

Objective: Prognostic factors of favorable or unfavorable clinical outcome after aneurysmal subarachnoid hemorrhage are still not completely known. We retrospectively analyzed factors associated with good clinical outcome of patients with subarachnoid hemorrhage (SAH) caused by aneurysms of the internal carotid artery.

Method: Patients with SAH were entered into a prospectively collected database. We retrospectively selected the patients with an aneurysm at carotid bifurcation (n=23) or posterior communicating artery (PCom) (n=170). In all patients, cerebral vasospasm (CVS) was treated by modified triple- H -therapy. Selected patients were additionally treated by intraarterial nimodipine administration. Outcome was assessed using the modified Rankin Scale (mRS; favorable (mRS 0-2) and unfavorable (mRS 3-6)) six months after SAH.

Results: A good clinical status at admission (WFNS grade I-III) had a significant influence on mRS six month after subarachnoid hemorrhage (p<0.001). In univariate analysis also elderly age, Fisher grade 3 (p<0.05), early hydrocephalus (p=0.0001), severity of CVS (CVS>33% p<0.001; CVS>66% p<0.001), longer stay on the ICU (p<0.001) and Pcom- aneurysm (p<0.05) were associated with unfavorable outcome. Multivariate analysis showed four prognostic factors for a favorable outcome: good admission status (odds ratio (OR) 10.9), carotid-T aneurysm (OR 4.3), absence of mild and/ or severe CVS (OR 3.4) and age <55 years (OR 2.1).

Conclusions: Despite the usual prognostic factors (good admission status, younger age, absence of CVS) for a favorable outcome after SAH, interestingly the aneurysm location (carotid bifurcation) seems to be a prognostic factor compared to SAH from a Pcom aneurysm. In statistically analysis aneurysms of the carotid bifurcation showed better clinical outcome and less occurrence of an early hydrocephalus – one factor of early brain injury (EBI). According to these results we question if the actual used experimental models for the exploration of EBI and CVS in humans have to be reevaluated. Due to the small number of patients with carotid bifurcation aneurysms (n=23) further studies have to be necessary to evaluate this in a greater population. A pooling of data may be helpful for a statement concerning the validity and possible improvements of the actual rat models.