Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry

Abstract

Background

The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.

Objective

To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.

Methods

This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.

Results

From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.

Conclusions

In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.

Appendix. List of contributors to the Swiss SOS study group

• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Zurich University Hospital, University of Zurich, Zurich, Switzerland

○ Kulcsàr Zsolt, MD

• Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Switzerland

○ Emanuela Keller, MD

○ Luca Regli, MD

○ Oliver Bozinov, MD

○ Sina Finkenstädt, MD

• Department of Neurosurgery, Inselspital Bern, Bern, Switzerland

○ Daniel Schöni, MD

○ Andreas Raabe, MD

○ Jürgen Beck, MD

○ Johannes Goldberg, MD

• Department of Neurosurgery, University Hospital Basel, Basel, Switzerland

○ Luigi Mariani, MD

○ Raphael Guzman, MD

• Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

○ Javier Fandino, MD

○ Daniel Coluccia, MD

• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Ospedale Civico di Lugano, Lugano, Switzerland

○ Cianfoni Alessandro, MD

• Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland

○ Daniele Valsecchi, MD

○ Alessio Chiappini, MD

○ Alice Venier, MD

○ Michael Reinert, MD

• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland

○ Johannes Weber, MD

• Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland

○ Andrea Ferrari, MD

○ Astrid Weyerbrock, MD

○ Gerhard Hildebrandt, MD

○ Martin Hlavica, MD

• Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Hopitaux Universitaires Genève, Geneva, Switzerland

○ Vitor Mendes Pereira, MD

• Department of Neurosurgery, Hopitaux Universitaires de Genève, Geneva, Switzerland

○ Marco Corniola, MD

○ Karl Schaller, MD