title: Ultra-early versus delayed coil treatment for ruptured poor-grade aneurysm.
abstract: BACKGROUND
  The timing of definitive aneurysm treatment (coiling or clipping) in poor-grade (Hunt-Hess IV or V) subarachnoid haemorrhage (SAH) patients has been a controversial topic. The purpose of this retrospective study was to analyse whether ultra-early coiling of ruptured intracranial aneurysms improves the clinical outcomes of poor-grade SAH patients.
  
  
  METHODS
  The records of patients with aneurysmal SAH who were treated with endovascular coiling were retrieved. The patients were classified into two groups: group A (patients coiled within 24 h of SAH) and group B (patients coiled ≥ 24 h after SAH). For each group, the patient demographics, Fisher grade, aneurysm characteristics and clinical outcomes were recorded. Outcomes were measured at 6 months using the modified Rankin Scale (mRS).
  
  
  RESULTS
  Thirty-one patients were coiled within 24 h of SAH (group A), and fourteen patients were coiled ≥24 h after SAH (group B). Groups A and B had similar clinical and angiographic characteristics. The clinical outcomes showed that a total of 58.1% of the patients (18 of 31) in group A were independent (mRS 0-2) compared with 21.4% of the patients (3 of 14) in group B (P = .028). Univariate analysis demonstrated that ultra-early coiling (P = .028) proved to be an independent predictor of better clinical outcomes (mRS 0-2).
  
  
  CONCLUSIONS
  Ultra-early (<24 h after SAH) coiling of ruptured aneurysms was associated with improved clinical outcomes compared to coiling at ≥24 h in poor-grade SAH patients. Larger, prospective studies are required to adequately assess the outcome differences between these two groups.
authors.affiliation: Department of Neurosurgery, The Military General Hospital of Beijing PLA, No. 5, Nanmencang Alley, Dongcheng District, Beijing, 100010, China.
authors.forename: Yong-Chun
authors.initials: YC
authors.lastname: Luo
authors.forename: Chun-Sen
authors.initials: CS
authors.lastname: Shen
authors.forename: Jin-Long
authors.initials: JL
authors.lastname: Mao
authors.forename: Chun-Yang
authors.initials: CY
authors.lastname: Liang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
authors.forename: Zi-Jun
authors.initials: ZJ
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists