Introduction
Methods and materials
Kuopio University Hospital (KUH) and aSAH management protocol in Eastern Finland
Kuopio Intracranial Aneurysm Patient and Family Database
Basic study population of 269 aSAH patients in poor condition on admission
Clinical condition on admission | H&H 4 patients | H&H 5 patients | ||||||
---|---|---|---|---|---|---|---|---|
On admission, n = 145 | Alive at 12 months, n = 91 (63%) | Alive at 3 years, n = 88 (61%) | On admission, n = 124 | Alive at 12 months, n = 34 (27%) | Alive at 3 years, n = 32 (26%) | |||
Median age at aSAH (years) (IQR) | 56 (49–64) | 53 (45–62) | 53 (45–61) | 59 (48–66) | 50 (45–60) | 49 (44–60) | ||
Females (%) Males (%) | 90 (62) 55 (38) | 59 (65) 32 (35) | 58 (66) 30 (34) | 72 (58) 52 (42) | 17 (50) 17 (50) | 15 (47) 17 (53) | ||
Multiple sIAs (%) | 53 (37) | 33 (36) | 32 (36) | 28 (23) | 10 (29) | 10 (31) | ||
Intracerebral hematoma (ICH) (%) | 96 (66) | 58 (64) | 55 (63) | 62 (50) | 16 (47) | 16 (50) | ||
Intraventricular hematoma (IVH) Blood clot (%) Blood sediment in occipital horns of lateral ventricles (%) | 41 (28) 67 (46) | 22 (24) 42 (46) | 22 (25) 41 (47) | 51 (41) 36 (29) | 11 (32) 18 (53) | 9 (28) 18 (56) | ||
Hydrocephalus on admission (%) | 97 (67) | 57 (63) | 54 (61) | 83 (67) | 23 (68) | 22 (69) | ||
Extraventricular drainage (%) | 127 (88) | 78 (86) | 76 (86) | 83 (67) | 31 (91) | 29 (91) | ||
Ruptured sIA/median size, mm (IQR) | 7 (5–10) | 7 (5–10) | 7 (5–10) | 8 (5–14) | 7 (5–10) | 7 (5–10) | ||
Location | Total (%), n=269 | ICH (%), n=158 (59) | ||||||
ICA | 51 (19) | 29/51 (57) | 25 (17) | 11 (12) | 10 (11) | 26 (21) | 5 (15) | 5 (16) |
AComA | 33 (12) | 17/33 (52) | 21 (14) | 17 (19) | 17 (19) | 12 (10) | 7 (21) | 7 (22) |
Other ACA | 23 (9) | 17/23 (74) | 13 (9) | 3 (3) | 3 (3) | 10 (8) | 0 (0) | 0 (0) |
MCA | 102 (38) | 85/102 (83) | 58 (40) | 43 (47) | 42 (48) | 44 (35) | 15 (44) | 15 (47) |
BA | 44 (16) | 10/44 (23) | 21 (14) | 14 (15) | 13 (15) | 23 (19) | 4 (12) | 2 (6) |
PICA | 16 (6) | 0/16 (0) | 7 (5) | 3 (3) | 3 (3) | 9 (7) | 3 (9) | 3 (9) |
Microsurgical occlusion of ruptured sIA (%) | 55 (38) | 41 (45) | 40 (45) | 25 (20) | 15 (44) | 15 (47) | ||
Endovascular occlusion of ruptured sIA (%) | 77 (53) | 48 (53) | 47 (53) | 34 (27) | 19 (56) | 17 (53) | ||
No sIA occlusion (%) | 13 (9) | 2 (2) | 1 (1) | 65 (52) | 0 (0) | 0 (0) | ||
Decompressive craniectomy (%) | 22 (15) | 10 (11) | 10 (11) | 13 (10) | 6 (18) | 6 (19) | ||
Brain dead in 2 weeks and organ donor (%) | 10 (7) | n.r. | n.r. | 29 (23) | n.r. | n.r. | ||
Shunt installed (%) | 43 (30) | 37 (41) | 35 (40) | 23 (19) | 22 (65) | 20 (63) |
Final study population of 120 aSAH patients alive at 3 years
Total alive at 3 years | Median mRS | mRS 0 (n = 17) | mRS 1 (n = 37) | mRS 2 (n = 20) | mRS 3 (n = 16) | mRS 4 (n = 23) | mRS 5 (n = 7) | P values | |
---|---|---|---|---|---|---|---|---|---|
mRS at 3 years, % (n) | 100% (120) | 2 | 14% (17 / 120) | 31% (37 / 120) | 17% (20 / 120) | 13% (16 / 120) | 19% (23 / 120) | 6% (7 / 120) | ref |
Median age at aSAH, years (IQR) | 52 (45–60) | 50 (46–57) | 54 (48–60) | 49 (34–60) | 53 (39–65) | 52 (45–66) | 54 (51–64) | ns | |
Females, % (n) | 61% (73) | 2 | 76% (13 / 17) | 57% (21 / 37) | 65% (13 / 20) | 44% (7 / 16) | 65% (15 / 23) | 57% (4 / 7) | ns |
H&H 4, % (n) | 73% (88) | 2 | 82% (14 / 17) 16% (14 / 88) | 70% (26 / 37) 29% (26 / 88) | 60% (12 / 20) 14% (12 / 88) | 81% (13 / 16) 15% (13 / 88) | 74% (17 / 23) 19% (17 / 88) | 86% (6 / 7) 7% (6 / 88) | ns |
H&H 5, % (n) | 27% (32) | 2 | 18% (3 / 17) 9% (3 / 32) | 30% (11 / 37) 35% (11 / 32) | 40% (8 / 20) 25% (8 / 32) | 19% (3 / 16) 9% (3 / 32) | 26% (6 / 23) 19% (6 / 32) | 14% (1 / 7) 3% (1 / 32) | ns |
ICH, % (n) | 59% (71) | 3 | 29% (5 / 17) 7% (5 / 71) | 51% (19 / 37) 27% (19 / 71) | 55% (11 / 20) 15% (11 / 71) | 75% (12 / 16) 17% (12 / 71) | 83% (19 / 23) 27% (19 / 71) | 71% (5 / 7) 7% (5 / 71) | 0.01 |
Median ICH volume, cm3 (IQR) | 22 (11–56) | 7 (3–17) | 18 (9–28) | 16 (4–55) | 35 (16–45) | 64 (42–101) | 17 (4–48) | < 0.01 | |
IVH, blood clot, % (n) | 26% (31) | 1 | 29% (5 / 17) | 32% (12 / 37) | 10% (2 / 20) | 31% (5 / 16) | 22% (5 / 23) | 29% (2 / 7) | ns |
IVH, blood sediment only, % (n) | 49% (59) | 2 | 59% (10 / 17) | 43% (16 / 37) | 60% (12 / 20) | 38% (6 / 16) | 43% (10 / 23) | 71% (5 / 7) | ns |
Shunted hydrocephalus, % (n) | 46% (55) | 2 | 35% (6 / 17) | 51% (19 / 37) | 40% (8 / 20) | 44% (7 / 16) | 48% (11 / 23) | 57% (4 / 7) | ns |
Epilepsy only after aSAH, % (n) | 28% (33) | 3 | na* | 22% (8 / 37) | 30% (6 / 20) | 38% (6 / 16) | 48% (11 / 23) | 29% (2 / 7) | ns |
Depression only after aSAH, % (n) | 28% (33) | 3 | na* | 35% (13 / 37) | 15% (3 / 20) | 31% (5 / 16) | 43% (10 / 23) | 29% (2 / 7) | ns |
Psychosis only after aSAH, % (n) | 13% (16) | 1 | na* | 27% (10 / 37) | 5% (1 / 20) | 13% (2 / 16) | 13% (3 / 23) | 0% (0 / 7) | ns |
Drug treated hypertension, % (n) | 66% (79) | 1 | 76% (13 / 17) | 73% (27 / 37) | 50% (10 / 20) | 63% (10 / 16) | 65% (15 / 23) | 57% (4 / 7) | ns |
Drug treated diabetes type 2, % (n) | 6% (7) | 1 | 6% (1 / 17) | 8% (3 / 37) | 0% (0 / 20) | 13% (2 / 16) | 0% (0 / 23) | 14% (1 / 7) | ns |