Impact of Introducing Endovascular Treatment on Acute Phase of Subarachnoid Haemorrhage Outcome

Abstract

Introduction: Ruptured intracranial aneurysm is an urgent diagnostic and therapeutic condition. Occlusion with coils is the first line treatment for ruptured aneurysms and also should be used to prevent re-rupture, potentially causing severe brain damage. Most aneurysms are subject to this type of treatment. The risk of intraoperative thromboembolic and haemorrhagic complications during treatment with coils is very low. Endovascular treatment with coils is therefore a safe and effective method that can prevent short and long-term haemorrhage. Short and long-term haemorrhage is achieved by early recanalization of cases with neuro-visualisation. Methods: In this article we present a retrospective analysis of the results of endovascular embolization of 137 patients, from 2017 to the present time, in three hospitals of Georgia country (Evex hospitals, New hospitals, New-vision University Hospital) with a diagnosis of acute subarachnoid haemorrhage. Results: In our study, overall postoperative mortality was reported to be 29.9% (41/137 patients). In 45 patients presenting with Hunt-Hess IV-V, the mortality rate was 51.1% (23/45). According to Raymond-Roy Scale, complete occlusion of aneurysm occurs in 66% of cases, residual occlusion of neck in 26%, and partial occlusion in 6%. Conclusion: Aneurysm rupture is an urgent clinical condition requiring rapid diagnosis and treatment. To prevent aneurysm re-rupture, operative intervention should be performed quickly. The recommended time interval is within 72 hours, and, if possible, within 24 hours after aneurysm rupture. Given the spasms typical of subarachnoid haemorraghe endovascular coiling of ruptured aneurysms is a first-line treatment that depends on the angioarchitecture and localization of the aneurysm. The main technique of endovascular treatment is occlusion by coils with or without remodeling balloon assistance. Generally, in acute periods, only aneurysms with coils are associated with relatively high rates of recanalization, so further observation and possible surgical treatment are recommended.