Skip to main content Skip to main navigation menu Skip to site footer

Comparison of outcomes between a ruptured and unruptured intracranial aneurysm: results from an Indonesian cohort study

  • Julius July ,
  • Patrick Putra Lukito ,
  • Vanessa Angelica ,
  • Jeremiah Hilkiah Wijaya ,
  • Audrey Hamdoyo ,
  • Nyoman Aditya Sindunata ,
  • Rusli Muljadi ,


Abstract

Purpose: A ruptured intracranial aneurysm has a high mortality rate. Moreover, many of its surviving patients have to live with severe disabilities. Therefore, surgical or endovascular treatment is recommended in some patients with a known aneurysm and a high risk of rupture. However, many patients are reluctant to undergo treatment, fearing its complications. This study aimed to evaluate the treatment outcomes and safety in patients with a ruptured and unruptured intracranial aneurysm.

Methods: We retrospectively reviewed the records of patients treated for intracranial aneurysms in our hospital between 2017 to 2021. Our primary outcome was discharge functional outcome. We also evaluated cerebral infarction, stay duration, and mortality. We used bivariate and multivariate analysis.

Results: 85 patients were included in this study. 69 (77.5%) patients were treated after rupture. Most patients were treated with clipping (78.8%). Patients with a ruptured aneurysm significantly had a higher risk of poor discharge functional outcome (OR 5.708 [1.061 – 30.712]; p 0.042). Six patients with a ruptured aneurysm died. Patients with a ruptured aneurysm also spent more time at the hospital. There was no mortality or complication in patients with an unruptured aneurysm.

Conclusion: Patients treated before their aneurysms ruptured had better outcomes with no complications. Therefore, treatment should be considered for high-risk patients.

Keywords: aneurysmal subarachnoid hemorrhage clipping coiling functional outcome

References

  1. Chan V, Lindsay P, McQuiggan J, Zagorski B, Hill MD, O’Kelly C. Declining Admission and Mortality Rates for Subarachnoid Hemorrhage in Canada between 2004 and 2015. Stroke. 2019;50(1):181-184. doi:10.1161/STROKEAHA.118.022332
  2. Liu GL, Luo J, Ping Zhang L, et al. Meta-Analysis of the Effectiveness and Safety of Prophylactic Use of Nimodipine in Patients with an Aneurysmal Subarachnoid Haemorrhage. CNS Neurol Disord - Drug Targets. 2012;10(7):834-844. doi:10.2174/187152711798072383
  3. Endo H, Hagihara Y, Kimura N, et al. Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients. J Neurosurg. Published online 2022:1-11. doi:10.3171/2022.2.jns212914
  4. Lukito PP, Lie H, Helsa K, July J. Heparin in the treatment of aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Focus. 2022;52(3). doi:10.3171/2021.12.FOCUS21419
  5. Inagawa T. Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan. J Neurosurg. 2005;102(1):60-67. doi:10.3171/jns.2005.102.1.0060
  6. Feigin VL, Rinkel GJE, Lawes CMM, et al. Risk factors for subarachnoid hemorrhage: An updated systematic review of epidemiological studies. Stroke. 2005;36(12):2773-2780. doi:10.1161/01.STR.0000190838.02954.e8
  7. Kim B soo. Unruptured Intracranial Aneurysm: Screening, Prevalence and Risk Factors. Neurointervention. 2021;16(3):201-203. doi:10.5469/neuroint.2021.00451
  8. Thompson BG, Brown RD, Amin-Hanjani S, et al. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(8):2368-2400. doi:10.1161/STR.0000000000000070
  9. Mijiti M, Mijiti P, Axier A, et al. Incidence and predictors of angiographic vasospasm, symptomatic vasospasm and cerebral infarction in chinese patients with aneurysmal subarachnoid hemorrhage. PLoS One. 2016;11(12). doi:10.1371/journal.pone.0168657
  10. Schatlo B, Fung C, Stienen MN, et al. Incidence and Outcome of Aneurysmal Subarachnoid Hemorrhage: The Swiss Study on Subarachnoid Hemorrhage (Swiss SOS). Stroke. Published online 2020:344-347. doi:10.1161/STROKEAHA.120.029538
  11. Al-Khindi T, MacDonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke. 2010;41(8). doi:10.1161/STROKEAHA.110.581975
  12. Macdonald RL, Schweizer TA. Spontaneous subarachnoid haemorrhage. Lancet. 2017;389(10069):655-666. doi:10.1016/S0140-6736(16)30668-7
  13. Geraghty JR, Testai FD. Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: Beyond Vasospasm and Towards a Multifactorial Pathophysiology. Curr Atheroscler Rep. 2017;19(12). doi:10.1007/s11883-017-0690-x
  14. Morita A, Kirino T, Hashi K, et al. The Natural Course of Unruptured Cerebral Aneurysms in a Japanese Cohort. N Engl J Med. 2012;366(26):2474-2482. doi:10.1056/nejmoa1113260
  15. Rawal G, Yadav S, Kumar R. Post-intensive care syndrome: An overview. J Transl Intern Med. 2017;5(2):90-92. doi:10.1515/jtim-2016-0016
  16. Salem MM, Maragkos GA, Gomez-Pa S, et al. Trends of ruptured and unruptured aneurysms treatment in the united states in post-isat era: A national inpatient sample analysis. J Am Heart Assoc. 2021;10(4):1-10. doi:10.1161/JAHA.120.016998
  17. Park HR, Kim JH, Park S, Chang JC, Park SQ. National trends in the treatment of ruptured cerebral aneurysms in korea using an age-adjusted method. J Korean Med Sci. 2020;35(39). doi:10.3346/JKMS.2020.35.E323

How to Cite

Julius July, Lukito, P. P., Angelica, V., Wijaya, J. H., Hamdoyo, A., Sindunata, N. A., & Rusli Muljadi. (2022). Comparison of outcomes between a ruptured and unruptured intracranial aneurysm: results from an Indonesian cohort study. Bali Medical Journal, 11(3), 1892–1896. https://doi.org/10.15562/bmj.v11i3.3725
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
2

Total
0

Share

Search Panel

Julius July
Google Scholar
Pubmed
BMJ Journal

Patrick Putra Lukito
Google Scholar
Pubmed
BMJ Journal

Vanessa Angelica
Google Scholar
Pubmed
BMJ Journal

Jeremiah Hilkiah Wijaya
Google Scholar
Pubmed
BMJ Journal

Audrey Hamdoyo
Google Scholar
Pubmed
BMJ Journal

Nyoman Aditya Sindunata
Google Scholar
Pubmed
BMJ Journal

Rusli Muljadi
Google Scholar
Pubmed
BMJ Journal