title: Contribution of endovascular therapy to the management of poor-grade aneurysmal subarachnoid hemorrhage: Clinical and angiographic outcomes.
abstract: OBJECTIVE
  Treatment of patients presenting with poor-grade (Hunt and Hess Grade IV or V) subarachnoid hemorrhage (SAH) is controversial. Endovascular coil embolization has been considered a valuable therapeutic alternative to surgical clip placement for this kind of patient. The aim of the present study was to evaluate immediate and long-term angiographic and clinical outcomes in patients with poor-grade SAH treated by endovascular embolization.
  
  
  METHODS
  One hundred eleven patients with Hunt and Hess Grade IV or V SAH were treated with endovascular embolization at the University of California at Los Angeles Medical Center between October 1990 and December 2004. Eighty patients harbored Grade IV hemorrhages and 31 patients had Grade V ones. Immediate and long-term anatomical and clinical outcomes were evaluated in all patients. Long-term clinical outcome assessments were based on follow-up data obtained over an average of 32 months posttherapy. Technical complications occurred in 15 patients (13.5%). Immediate complete aneurysm occlusion was observed in 51.4% of aneurysms. Angiographic, long-term follow-up review revealed aneurysm recanalization in 16.2% of cases. Thirty-nine patients (35.1%) demonstrated a favorable long-term clinical outcome. The overall mortality rate in this patient series was 32.4%. The mortality rate associated with vasospasm was significantly higher in patients with Grade IV SAHs than in those with Grade V hemorrhages.
  
  
  CONCLUSIONS
  The results of this study demonstrate a valuable contribution of endovascular therapy of ruptured intracranial aneurysms in patients with Hunt and Hess Grade IV or V SAH. This technique was successful in decreasing repeated aneurysm rupture and in enabling aggressive medical management during the acute phase of SAH. This is particularly important in patients with Grade IV SAH because of their potential for obtaining higher physical and functional recoveries.
authors.affiliation: Division of Interventional Neuroradiology, Department of Radiological Sciences, University of California at Los Angeles, California 90095-1721, USA. ssuzuki@mednet.ucla.edu
authors.forename: Shuichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
authors.forename: John
authors.initials: J
authors.lastname: Frazee
authors.forename: Neil
authors.initials: N
authors.lastname: Martin
authors.forename: Fernando
authors.initials: F
authors.lastname: Viñuela
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017130:Angioplasty; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome