title: Treatment of poor-grade subarachnoid hemorrhage trial.
abstract: OBJECTIVE
  Management of poor-grade subarachnoid hemorrhage is based on limited evidence from small single-center retrospective observational studies. The purpose of this study was to undertake a single-center randomized controlled feasibility trial comparing a strategy of early endovascular aneurysm treatment with treatment after neurologic recovery in this group of patients.
  
  
  METHODS
  Patients with poor-grade SAH were randomized within 24 hours of admission to early treatment or treatment after neurologic recovery. If a patient was randomized to early treatment, the aneurysm was treated endovascularly within 24 hours of randomization. Recruitment rate, safety profile, and functional outcome at the time of discharge and at 6 months were assessed.
  
  
  RESULTS
  Fourteen of 51 patients screened were eligible for the trial. Of these 14, 8 patients were randomized (57%). All patients in the early coiling arm received treatment within 24 hours of randomization. There was no treatment-related complication. Overall, good outcome occurred in 25% of patients; the mortality rate was 75%. Patients in the early treatment arm (n = 5) had a good outcome rate of 20%, while those in treatment after neurologic recovery arm (n = 3) had a good outcome rate of 33.3%.
  
  
  CONCLUSIONS
  This was a feasibility study that demonstrated that recruitment and randomization for comparing management strategies in poor-grade SAH are feasible. The recruitment rate among eligible patients was encouraging (57%), though a number of patients had to be excluded due to ineligibility. A multicenter study is necessary to recruit the numbers required to compare the clinical outcomes of these management strategies.
authors: From the Departments of Neuroradiology (D.M., V.J., A.G.) Dipayan.Mitra@nuth.nhs.uk.
authors: D
authors: D
authors: Mitra
authors: Neurosciences (B.G.), Newcastle University, Newcastle upon Tyne, United Kingdom.
authors: B
authors: B
authors: Gregson
authors: From the Departments of Neuroradiology (D.M., V.J., A.G.).
authors: V
authors: V
authors: Jayakrishnan
authors: From the Departments of Neuroradiology (D.M., V.J., A.G.).
authors: A
authors: A
authors: Gholkar
authors: Anesthesiology and Intensive Care (A.V.), Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
authors: A
authors: A
authors: Vincent
authors: Institutes of Aging and Health (P.W.).
authors: P
authors: P
authors: White
authors: Neurosurgery (P.M.).
authors: P
authors: P
authors: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome