title: Hyperacute versus Subacute Coiling of Aneurysmal Subarachnoid Hemorrhage a Short-term Outcome and Single-Center Experience, Pilot Study.
abstract: BACKGROUND
  After the initial subarachnoid hemorrhage (SAH), rebleeding is the major cause of morbidity and poor outcome, which is maximal in the first 24 h. We supposed that the coiling of ruptured intracranial aneurysms within 24 h of SAH is related to the improved clinical outcome compared with coiling 24 h after aneurysmal SAH.
  
  
  OBJECTIVE
  We examined whether coiling ruptured aneurysms within 24 h of aneurysmal SAH is associated with better early 24 h and late 30 days outcome.
  
  
  METHODS
  This prospective study was carried on 30 patients with aneurysmal SAH presenting to the Alexandria University Hospital and Insurance Main Hospital during the period from February 2013 to May 2014. They were divided into two groups: Group I (10 patients treated within 24 h of presentation) and Group II (20 patients treated after 24 h of presentation). Time interval from presentation to treatment were 78.60 and 10.60 h for subacute and hyperacute group, respectively. All patients were treated with endovascular coiling. Change between admission and immediate postoperative World Federation of Neurosurgeons classification Scale was measured for early outcome, while remote outcome was measured by modified Rankin Scale at 30 days follow-up.
  
  
  RESULTS
  There was a clinical improvement regarding early 24 h outcome (weighted by postoperative WFNS grade) and on late 30 days outcome (weighted by Modified Rankin Scale Score) in the group managed within 24 h versus who were treated after 24 h (P = 0.049 and P = 0.024, respectively). There was a significant decrease in the incidence of clinical rebleeding detected by postoperative computed tomography (CT) of the brain in patients undergoing aneurysm treatment within 24 h (P = 0.029).
  
  
  CONCLUSIONS
  The study affirms evidence that the management of ruptured intracranial aneurysms within 24 h of SAH is associated with better immediate and short-term clinical outcome.
authors.affiliation: Department of Neurology and Psychiatry, Faculty of Medicine, University of Alexandria , Alexandria , Egypt.
authors.forename: Abdulrahman Mostafa
authors.initials: AM
authors.lastname: Ibrahim Ali
authors.affiliation: Department of Neurology and Psychiatry, Faculty of Medicine, University of Alexandria , Alexandria , Egypt.
authors.forename: Ghada Abdel Hady Ossman
authors.initials: GA
authors.lastname: Ashmawy
authors.affiliation: Department of Neurology and Psychiatry, Faculty of Medicine, University of Alexandria , Alexandria , Egypt.
authors.forename: Ayman Youssef Ezeddin
authors.initials: AY
authors.lastname: Eassa
authors.affiliation: Department of Neurology and Psychiatry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt; Stroke Center, Alexandria University Hospital, Alexandria, Egypt.
authors.forename: Osama Yassin
authors.initials: OY
authors.lastname: Mansour
keywords: aneurysm; endovascular treatment; outcome; subarachnoid hemorrhage; timing