Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage

Andrew M. Naidech, Nazli Janjua, Kurt T. Kreiter, Noeleen D. Ostapkovich, Brian Fred Fitzsimmons, Augusto Parra, Christopher Commichau, E. Sander Connolly, Stephan A. Mayer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

208 Scopus citations

Abstract

Background: Aneurysm rebleeding has historically been an important cause of mortality after subarachnoid hemorrhage (SAH). Objective: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, which emphasizes early surgical or endovascular treatment. Design: Inception cohort. Setting: Tertiary care medical center. Patients: A total of 574 patients enrolled in the Columbia University SAH Outcomes Project between August 1996 and June 2002. Early aneurysm repair was performed whenever feasible. Main Outcome Measures: Rebleeding was defined by prespecified clinical and radiographic criteria, excluding prehospital, intraprocedural, and postrepair events. Functional outcome was assessed at 3 months with the modified Rankin Scale. Multiple logistic regression was used to identify predictors of rebleeding, poor functional outcome, and mortality. Results: Rebleeding occurred in 40 (6.9%) of the 574 patients; most cases (73%) occurred within 3 days of ictus. Hunt-Hess grade on admission (odds ratio [OR], 1.92 per grade; 95% confidence interval [CI], 1.33-2.75; P<.001) and maximal aneurysm diameter (OR, 1.07/ mm; 95% CI, 1.01-1.13; P=.005) were independent predictors of rebleeding. After controlling for Hunt-Hess grade and aneurysm size, rebleeding was associated with a markedly reduced chance of survival with functional independence (modified Rankin Scale score, ≤4; OR, 0.08; 95% CI, 0.02-0.34) at 3 months. Conclusions: Despite an aggressive management strategy, rebleeding still occurred in 6.9% of patients and was associated with a dismal outcome. Poor Hunt-Hess grade and larger aneurysm size are related to rebleeding. Pharmacologic therapy to reduce the risk of rebleeding before aneurysm repair, particularly in patients with poor grade neurologic status and large aneurysms, deserves renewed attention.

Original languageEnglish (US)
Pages (from-to)410-416
Number of pages7
JournalArchives of Neurology
Volume62
Issue number3
DOIs
StatePublished - Mar 2005

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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