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Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry

Rodolfo Maduri, Daniele Starnoni, Alda Rocca, David Bervini, Daniel Walter Zumofen, Martin Nikolaus Stienen, Bawarjan Schatlo, Christian Fung, Thomas Robert, Martin A Seule, Jan-Karl Burkhardt, Nicolai Maldaner, Michel Rothlisberger, Kristine A Blackham, Serge Marbacher, Donato D'Alonzo, Luca Remonda, Paolo Machi, Jan Gralla, Philippe Bijlenga, Guillaume Saliou, Pierluigi Ballabeni, Marc Levivier, Mahmoud Messerer, Roy Thomas Daniel & Swiss SOS Group

abstract

BACKGROUND
The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.

OBJECTIVE
To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.

METHODS
This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.

RESULTS
From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.

CONCLUSIONS
In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.
   
citation Maduri R, Starnoni D, Rocca A, Bervini D, Zumofen D W, Stienen M N, Schatlo B, Fung C, Robert T, Seule M A, Burkhardt J K, Maldaner N, Rothlisberger M, Blackham K A, Marbacher S, D'Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel R T, Swiss SOS Group . Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry. Acta Neurochir (Wien) 2019; 161:769-779.
   
type journal paper/review (English)
date of publishing 25-01-2019
journal title Acta Neurochir (Wien) (161/4)
ISSN electronic 0942-0940
pages 769-779
PubMed 30680461
DOI 10.1007/s00701-019-03812-9