Occurrence and impact of delayed cerebral ischemia after coiling and after clipping in the International Subarachnoid Aneurysm Trial (ISAT) |
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Authors: | Sanne M Dorhout Mees Richard S Kerr Gabriel J E Rinkel Ale Algra Andrew J Molyneux |
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Institution: | (1) Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Room G03.228, PO Box 85500, 3508 GA Utrecht, The Netherlands;(2) Nuffield Department of Surgery, Neurovascular Research Unit, University of Oxford and Oxford Radcliffe Hospitals, National Health Service Trust, Radcliffe Infirmary, Oxford, United Kingdom;(3) Julius Centre for Health Sciences and Primary Care, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands |
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Abstract: | Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). We studied
differences in incidence and impact of DCI as defined clinically after coiling and after clipping in the International Subarachnoid
Aneurysm Trial. We calculated odds ratios (OR) for DCI for clipping versus coiling with logistic regression analysis. With
coiled patients without DCI as the reference group, we calculated ORs for poor outcome at 2 months and 1 year for coiled patients
with DCI and for clipped patients without, and with DCI. With these ORs, we calculated relative excess risk due to Interaction
(RERI). Clipping increased the risk of DCI compared to coiling in the 2,143 patients OR 1.24, 95% confidence interval (95%
CI 1.01–1.51). Coiled patients with DCI, clipped patients without DCI, and clipped patients with DCI all had higher risks
of poor outcome than coiled patients without DCI. Clipping and DCI showed no interaction for poor outcome at 2 months: RERI
0.12 (95% CI −1.16 to 1.40) or 1 year: RERI −0.48 (95% CI −1.69 to 0.74). Only for patients treated within 4 days, coiling
and DCI was associated with a poorer outcome at 1 year than clipping and DCI (RERI −2.02, 95% CI −3.97 to −0.08). DCI was
more common after clipping than after coiling in SAH patients in ISAT. Impact of DCI on poor outcome did not differ between
clipped and coiled patients, except for patients treated within 4 days, in whom DCI resulted more often in poor outcome after
coiling than after clipping. |
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