title: Endovascular treatment for poorest-grade subarachnoid hemorrhage in the acute stage: has the outcome been improved?
abstract: OBJECTIVE
  Patients with poor-grade subarachnoid hemorrhage (SAH) have been considered good candidates for endovascular treatment. The results of treatment of Grade V SAH, the poorest grade, however, have not been fully elucidated.
  
  
  METHODS
  The clinical characteristics and outcome parameters of 22 World Federation of Neurosurgical Societies Grade V SAH patients treated endovascularly in the acute stage between 1998 and 2000 are summarized and compared with those of 18 Grade V SAH patients treated conservatively between 1995 and 1997.
  
  
  RESULTS
  Among the 22 patients treated endovascularly, 8 patients (36.4%) survived. The rate was significantly higher than that of the 18 patients treated conservatively (5.6%), only one of whom survived. The favorable outcome rate, however, was not significantly different between the two groups (4.5% versus 6.0%). Subdivision of both treatment groups according to Glasgow Coma Scale (GCS) score showed that the improved survival among those treated endovascularly was attributable to the improved survival in those with a preprocedural GCS score of 6 but not of 4 or 5.
  
  
  CONCLUSIONS
  Endovascular treatment of the 22 World Federation of Neurosurgical Societies Grade V SAH patients improved their survival rate but not their favorable outcome rate in comparison with conservative treatment. Further accumulation of clinical data is essential to determine whether endovascular treatment can improve the functional outcome of those with GCS scores of 6 and whether there is no role for endovascular treatment in those with GCS scores of 4 or 5.
authors.affiliation: Department of Neurosurgery, National Tokyo Medical Center, Tokyo, Japan. GInamasu@aol.com
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Saito
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuroshima
authors.forename: Keita
authors.initials: K
authors.lastname: Mayanagi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ichikizaki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology* / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome