Analysis Of Clinical Prognostic Factors Of Different Treatment Methods In Patients With High-Grade Aneurysmal Subarachnoid Hemorrhage

Objective:To compare the outcomes of neurosurgical clipping and endovascular coiling of poor-grade aneurysm patients.Methods:Clinical data of 181 poor-grade patients with world federation of neurosurgical societies(WFNS)grade Ⅳ(n=116)and Ⅴ(n=65)were analyzed retrospectively from January 2006 to December 2019 in our institution,including 72 males and 109 females.Surgical clipping was employed in 116 cases.Endovascular coiling was performed in 65 cases.Outcome of treatment were assessed using modified rankin scale MRS)at 6 months follow-up and stratified into good(MRS 0-2)versus poor(MRS 3-6)outcome.Results:In neurosurgical clipping group,good outcome at 6 months was observed in 40(34.5%)cases,poor outcome in 76(65.5%)cases,versus 37(56.9%),28(43.1%)cases in endovascular coiling group.There was significant difference in the outcome between the two treatments in WFNS grade Ⅳ-Ⅴ patients(P=0.003).Rebleeding before surgery,brain herniation,intracerebral hematoma(ICH)>30ml,decompressive craniectomy(DC),intraventricular hemorrhage(IVH),external ventricular drainage(EVD),low density area(LDA)and hydrocephalus were significant predictors of poor outcome.WFNS grade Ⅳ and lower CT fisher grade,endovascular coiling were associated with good outcomes.The multivariable logistic regression analysis showed that WFNS grade V,CT fisher 3-4grade and LDA were independent predictor for poor outcome.Conclusion:This study shows that either surgical clipping or interventional embolization is optional for high-grade patients with grade WFNS Ⅳ-Ⅴ,and that endovascular embolization may achieve better results.Preoperative rebleeding,cerebral hernia,cerebral hemorrhage>30ml,DC,IVH,EVD,LDA,and hydrocephalus were associated with a poor prognosis.The WFNS grade Ⅳ and low CT fisher grade were associated with a better prognosis.Although different treatment modalities were not randomized in our study,and the data were all retrospective,and factors such as patient family decisions and medical costs may lead to selection bias,the preliminary results of this study can be used as a reference for treating patients with high grade aneurysms.