Risk Factors Affecting Clinical Outcome of Ruptured Vertebrobasilar Saccular Aneurysms

ABSTRACT

OBJECTIVE: Ruptured vertebrobasilar (VB) saccular aneurysm is a difficult lesion to treat, and is associated with high rates of morbidity and mortality. The aim of this study is to investigate the risk factors associated with the clinical outcome of ruptured VB aneurysms. METHODS: A retrospective review of 29 patients with ruptured VB saccular aneurysms between 2002 and 2010 was conducted between Jan 2002 and Dec 2010. Univariate and multivariate analyses were performed for determination of the statistical significance of the Glasgow Outcome Scale (GOS) at three months, according to age, initial Hunt-Hess grade, the presence of acute hydrocephalus, and treatment modality. RESULTS: The study included 24 (82.7%) females and five (17.3%) males, with a mean age of 59 years (range, 22-78 years). Seventeen patients were treated with surgical clipping and 12 patients were treated with endovascular coil embolization. No statistical significance was observed between clinical outcome and treatment modalities (clipping or coiling; p = 0.803). Seventeen (58.6%) patients achieved favorable outcome, defined as GOS score of 4-5, at 3 months. Procedure-related complications occurred in seven patients (24.1%). Results of multivariate analysis indicated that initial Hunt-Hess grade and the presence of acute hydrocephalus were independent predictors of unfavorable outcome, defined as GOS score of 1-3 (Odds ratio (OR) = 8.63, Confidence interval (CI) [95%] 1.11-66.84, p = 0.039 and OR = 36.64, CI [95%] 2.23-599.54, p = 0.012, respectively). CONCLUSION: The present study suggests that the clinical outcomes are related to the initial Hunt-Hess grade and the presence of acute hydrocephalus in ruptured saccular VB aneurysms.