Neurointervention.  2019 Mar;14(1):35-42. 10.5469/neuroint.2018.01067.

External Ventricular Drainage before Endovascular Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage in Acute Period: Its Relation to Hemorrhagic Complications

Affiliations
  • 1Department of Neurosurgery, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea.
  • 2Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
  • 3Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.
  • 4Department of Neurosurgery, Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ns.joonho.chung@gmail.com
  • 5Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
The purpose of this study was to report the authors' experience with external ventricular drainage (EVD) before endovascular treatment (EVT) in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) and to investigate its relation to hemorrhagic complications. MATERIALS AND METHODS: Between March 2010 and December 2017, a total of 122 patients were recruited who had an aSAH, underwent EVT to secure the ruptured aneurysm, and had EVD performed within 72 hours of rupture. The pre-embo EVD group (n=67) comprised patients who underwent EVD before EVT, and the post-embo EVD group (n=55) comprised those who underwent EVD after EVT.
RESULTS
Overall, EVD-related hemorrhage occurred in 18 patients (14.8%): six (8.9%) in the pre-embo EVD group and 12 (21.8%) in the post-embo EVD group (P=0.065). No rebleeding occurred between EVD and EVT in the pre-embo EVD group. Clinical outcomes at discharge did not differ significantly between groups (P=0.384). At discharge, the final modified Rankin Scale score in patients who experienced pre-embo rebleeding was better in the pre-embo EVD group than in the post-embo EVD group (P=0.041). Current use of an antiplatelet agent or anticoagulant on admission (odds ratio [OR], 2.928; 95% confidence interval [CI], 1.234-7.439; P=0.042) and stent use (OR, 2.430; 95% CI, 1.524-7.613; P=0.047) remained independent risk factors for EVD-related hemorrhagic complications.
CONCLUSION
EVD before EVT in patients with aSAH in acute period did not increase the rate of rebleeding as well as EVD-related hemorrhagic complications. Thus, performing EVD before EVT may be beneficial by normalizing increased intracranial pressure. Especially in patients with rebleeding before the ruptured aneurysm is secured, pre-embo EVD may improve clinical outcomes at discharge.

Keyword

Hydrocephalus; Subarachnoid hemorrhage; Intracranial aneurysm; Aneurysm, Ruptured

MeSH Terms

Aneurysm*
Aneurysm, Ruptured
Drainage*
Hemorrhage
Humans
Hydrocephalus
Intracranial Aneurysm
Intracranial Pressure
Risk Factors
Rupture
Stents
Subarachnoid Hemorrhage*
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