title: Aneurysm treatment <24 versus 24-72 h after subarachnoid hemorrhage.
abstract: BACKGROUND
  In patients with aneurysmal subarachnoid hemorrhage (aSAH), it is unclear whether aneurysm treatment <24 h after ictus results in better outcomes than treatment 24-72 h after aSAH. We studied whether aneurysm occlusion <24 h is associated with better outcomes than occlusion 24-72 h after aSAH.
  
  
  METHODS
  We used two cohorts of patients with aSAH: (1) the UMC Utrecht cohort with patients admitted between 2008 and 2012 and (2) the International Subarachnoid Aneurysm Trial cohort. Aneurysm treatment was categorized into <24 h and 24-72 h after ictus. We calculated adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) using Poisson regression analyses for poor functional outcome (death or dependency) for both cohorts separately, and performed a pooled analysis based on individual patient data. We also performed a worst-case scenario analysis wherein all patients with rebleeding >3 h after admission were re-categorized into the group with aneurysm treatment 24-72 h after aSAH.
  
  
  RESULTS
  We included 1,238 patients (UMC Utrecht cohort: n = 330; ISAT: n = 908). The aRR for poor outcome after treatment <24 h was in the UMC Utrecht cohort 1.84 (95% CI: 1.25-2.70), in ISAT 1.14 (95% CI 0.84-1.55), in the pooled analysis 1.37 (95% CI 1.11-1.68), and in the worst-case scenario pooled analysis 1.24 (95% CI 1.01-1.52).
  
  
  CONCLUSIONS
  Our results suggest that aneurysm occlusion can be performed in day time within 72 h after ictus, instead of on an emergency basis. However, due to the retrospective, non-randomized design of our study, our results cannot be considered as definitive evidence.
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room G03-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Simone C
authors.initials: SC
authors.lastname: Oudshoorn
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Molyneux
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kerr
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Dorhout Mees
authors.forename: Daan
authors.initials: D
authors.lastname: Backes
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
mesh_terms: D000328:Adult; D000368:Aged; D057510:Endovascular Procedures / Q000592:standards*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019635:Neurosurgical Procedures / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome