Objective: The International Cooperative Study on the Timing of Aneurysm Surgery demonstrated that subarachnoid hemorrhage (SAH) patients who underwent surgery on post-hemorrhage days 4-10 had worse outcomes than patients treated on days 0-3 and days 11-14. Based on these findings, it was concluded that patients who present with SAH on days 4-10 should have aneurysm surgery delayed until after day 10. Since the study, coiling has become a treatment option and it is unclear whether these results apply to this new treatment modality. Our institution is a regional referral center for SAH, and patients are transferred at different time points after hemorrhage. We wanted to determine whether patients that arrive on days 4-10 were safe to undergo coiling immediately rather than waiting until after day 10.
Methods: We reviewed 119 consecutive SAH patients who underwent coiling between January 2006 and June 2008. Factors of age, gender, Hunt-Hess grade, Fisher score, aneurysm size and aneurysm location were included in a regression analysis to determine the effect of day of coiling on clinical outcome at discharge.
Results: Of 119 study patients, 86% had coiling on post-hemorrhage days 0-3, and 12% on days 4-10. Patients in these cohorts did not differ in any demographic factors. Age and Hunt-Hess grade were the only predictors of mortality (age p=0.0001, Hunt-Hess p=0.0110) and poor outcome, defined as death or discharge to a skilled nursing facility (age p=0.0001, Hunt-Hess p=0.0001). Day of coiling had no effect on mortality (p=0.5731) or poor outcome (p=0.1861).
Conclusions: Coiling of ruptured aneurysms can be performed safely on patients who arrive on post-hemorrhage days 4-10, and treatment need not be delayed after day 10, as the results of the Timing of Aneurysm Surgery Study initially suggested.