title: No long-term excess mortality in 280 patients with ruptured distal anterior cerebral artery aneurysms.
abstract: OBJECTIVE
  The aim of this study was to assess the long-term excess mortality after the rupture of distal anterior cerebral artery (DACA) aneurysms compared with that of a matched general Finnish population in an unselected, population-based series.
  
  
  METHODS
  We identified 280 consecutive patients (119 men, 161 women) treated for ruptured DACA aneurysms (clipped, 262; coiled, 10; no intervention, 8) at two neurosurgical centers serving solely the southern and eastern parts of Finland from 1976 to 2003. All patients were followed from subarachnoid hemorrhage until death or the end of 2004. No patients were lost to follow-up. Long-term excess mortality was estimated using the annual relative survival ratio compared with the general Finnish population matched by age, sex, and calendar time.
  
  
  RESULTS
  The median follow-up period was 9.6 years (range, 0.1-29 yr). The 3-year cumulative relative survival ratio was 0.84 (95% confidence interval, 0.78-0.88), implying 16% excess mortality in the patient group during the first 3 years after subarachnoid hemorrhage. The annual relative survival ratio attained 1.0 at the fourth year of follow-up, indicating no excess mortality thereafter. There were four episodes of recurrent subarachnoid hemorrhage and only one from a treated DACA aneurysm, with a 10-year cumulative risk of 1.4% (95% confidence interval, 0.0-3.0). Cardiovascular disease and cancer were the leading causes of death after 10 years of follow-up.
  
  
  CONCLUSIONS
  After surviving 3 years after the rupture of a DACA aneurysm, the patients' long-term survival became similar to that of the matched general population. Rebleeding of treated DACA aneurysm was rare.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. martin.lehecka@hus.fi
authors.forename: Martin
authors.initials: M
authors.lastname: Lehecka
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Johanna
authors.initials: J
authors.lastname: Seppänen
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.forename: Timo
authors.initials: T
authors.lastname: Koivisto
authors.forename: Antti
authors.initials: A
authors.lastname: Ronkainen
authors.forename: Jaakko
authors.initials: J
authors.lastname: Rinne
authors.forename: Risto
authors.initials: R
authors.lastname: Sankila
authors.forename: Juha
authors.initials: J
authors.lastname: Jääskeläinen
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D020771:Anterior Cerebral Artery / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D013995:Time