Propensity Score-matched Analysis Of The Effect Of Timing Of Endovascular Treatment On The Prognosis Of Patients With Aneurysmal Subarachnoid Hemorrhage

[Objective]The timing of endovascular treatment of acute aneurysmal subarachnoid hemorrhage is a controversial topic.Although most vascular neurosurgeons agree to early treatment of aneurysms(within the first 72 hours),it is controversial whether ultra-early treatment of aneurysms(within the first 24 hours)is beneficial.Our aim was to investigate the best time to improve the clinical outcome of patients with acute aneurysmal subarachnoid hemorrhage.[Methods]The clinical data of patients with aneurysmal subarachnoid hemorrhage who received interventional embolization in the third affiliated Hospital of Guangzhou Medical University from October 2017 to December 2020 were collected.A total of83 patients were included after exclusion.The patients who received surgical treatment within 24 hours were classified as ultra-early group,and the patients who received surgical treatment within 24-72 hours were classified as early group.The clinical factors in the patient’s medical history were retrospectively analyzed: timing of intervention,age,sex,hypertension,diabetes,preoperative Hunt-Hess grade,location of aneurysm,size of aneurysm,admission WFNS score,modified fisher score on admission,ischemic event,bleeding event,m RS score at discharge and death.Use SPSS(version 26.0 SPSS Inc.).Statistical analysis shows that p value less than0.05 is considered to be statistically significant.The effects of operation timing on the prognosis of patients with aneurysmal subarachnoid hemorrhage and the incidence of complications(hemorrhage,ischemia,shunt-dependent hydrocephalus)were statistically analyzed.[Results]After propensity score matching(PSM),there were 21 patients in the ultra-early group and 21 patients in the early group.In the ultra-early group,endovascular embolization began at 10.16 ± 5.14(mean ± standard deviation)hours after admission.At the same time,in the early group,endovascular embolization began at49.76 ± 19.10(mean ± standard deviation)hours after admission.There was significant difference in the timing of treatment between the two groups(P < 0.001).The incidence of bleeding events after the beginning of endovascular embolization was 0% in the ultra-early group(21 cases with 0 beat)and 4.8% in the early group(21cases with 1 stroke).There was no significant difference in the incidence of bleeding events between the two groups(Purge 1.000).The incidence of ischemic events after the beginning of endovascular embolization was 23.8%(21 cases)in the ultra-early group and 23.8%(21 cases in the early group).There was no significant difference in the incidence of ischemic events between the two groups(Purge 1.000).After the beginning of endovascular embolization,the incidence of chronic shunt-dependent hydrocephalus was 4.8%(21 cases)in the ultra-early group and 9.5%(21 cases in the early group).There was no significant difference in the incidence of chronic shunt-dependent hydrocephalus between the two groups(Purge 0.182).The rate of good prognosis(discharge m RS score ≤ 2)was 81.0%(17max 44)in the ultra-early group and 66.7%(14x21)in the early group,and the rate of poor prognosis(discharge m RS score > 2)was 15.9%(4max 21)in the ultra-early group and 23.1%(7max 21)in the early group.There was no significant difference in prognosis between the two groups(paired 0.298).The mortality rate during postoperative hospitalization was 0%in the ultra-early group(0%)and 14.3% in the early group(3pm 21).There was no significant difference between the two groups(Purge 0.232).[Conclusion]Compared with patients with Hunt-Hess I-III grade aneurysmal subarachnoid hemorrhage who received ultra-early intravascular therapy within 24 hours without bleeding before operation,early endovascular therapy within 3 days did not bring clinical benefit in terms of prognosis and complications(hemorrhage,ischemia,shunt-dependent hydrocephalus).And rebleeding before operation will lead to poor clinical outcome,the existing evidence of medical treatment to prevent preoperative bleeding is not sufficient,for patients with hunt-hess I-III grade a SAH who have the condition to receive ultra-early treatment,delayed treatment should also consider the risk of preoperative bleeding.