title: Suboptimal interventional conditions for the occlusion of ruptured intracranial aneurysms do not increase periprocedural complications and poor clinical outcomes.
abstract: OBJECTIVE
  Occluding a ruptured intracranial aneurysm as early as possible may entail certain periprocedural conditions that compromise the outcome. The aim of the present study was to evaluate the effectiveness, safety, and clinical outcome of endovascular coiling procedures performed on an emergency basis under potentially suboptimal conditions, and to compare results with those from scheduled procedures under potentially optimal conditions.
  
  
  METHODS
  Interventions performed on 66 SAH patients were retrospectively analysed by classifying them into two groups: under emergency (within three hours from diagnosis or during non-standard working hours) or scheduled conditions. A binary logistic regression analysis was also performed to identify characteristics associated with poor outcomes.
  
  
  RESULTS
  No differences in effectiveness, periprocedural complications, or clinical outcomes were found between the two groups. Rebleeding was detected in 4.8 % of the emergency interventions and 2.2 % of the scheduled interventions. Multivariate analysis identified age and Hunt and Hess grade, but no conditions of treatment, as the factors associated to poor outcome.
  
  
  CONCLUSIONS
  Suboptimal interventional conditions for occluding ruptured intracranial aneurysms, such as performing procedures outside of standard working hours or within three hours of diagnosis, do not result in increased periprocedural complications and poor clinical outcomes compared with scheduled procedures under potentially optimal conditions. These results suggest the need for treatment to be provided as soon as possible.
authors.affiliation: Department of Neurology, Hospital Clínico San Carlos, Avenida Prof. Martin Lagos, 28040, Madrid, Spain, jordimatiasguiu@hotmail.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Matías-Guiu
authors.forename: J
authors.initials: J
authors.lastname: Avecillas-Chasín
authors.forename: J A
authors.initials: JA
authors.lastname: Barcia
authors.forename: M
authors.initials: M
authors.lastname: Moreu
authors.forename: L
authors.initials: L
authors.lastname: López-Ibor
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology; D015994:Incidence; D002532:Intracranial Aneurysm / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010561:Personnel Staffing and Scheduling; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000453:epidemiology