Background: The outcomes of the grade V subarachnoid hemorrhage (SAH) patients have been dismal. Considering rapid advancement in techniques and devices in endovascular treatment (EVT), however, the outcomes of grade V SAH patients treated endovascularly may have been improved chronologically.
Methods: A single-center, retrospective study was conducted to evaluate whether the outcomes of World Federation of Neurosurgical Societies (WFNS) grade V SAH patients treated endovascularly were improved chronologically during the last 15 years (January 2000- December 2014). Coiling has been the first-line treatment for WFNS grade V SAH patients in our institution since 2000, and 115 patients who underwent EVT were trichotomized based on the admission year: 2000-04 (n=44), 2005-09 (n=37), and 2010-14 (n=34). Demographics and the outcomes were compared among the three groups. The outcomes at discharge were evaluated with the Glasgow Outcome Scale (GOS) score, and GOS 4/5 were defined as favorable outcomes.
Results: There were no significant intergroup differences in demographics. There were no significant differences in the frequencies of favorable outcomes (14% in 2000-04, 16% in 2005-09, and 26% in 2010-14). The in-hospital mortality rates were: 52% in 2000-04, 43% in 2005-09, and 24% in 2010-14. The mortality rate in 2010-14 was significantly lower than that in 2000-04 (p=0.01). The reason for chronological decrease in mortality may have been due to decrease in postoperative rebleeding and delayed cerebral ischemia (DCI), both of which were shown to have decreased chronologically: the frequencies of postoperative rebleeding were (11% in 2000-04, 8% in 2005-09, and 0% in 2010-14), and the frequencies of DCI were (36% in 2000-04, 26% in 2005-09, and 19% in 2010-14)
Conclusions: The outcomes of grade V SAH patients treated endovascularly have been improved chronologically. The improvement is more marked in the reduction of mortality. Although the frequencies of patients discharged with favorable outcomes have also increased chronologically, the differences were not significant and the reason for the increase is unclear. While EVT may be viable option for grade V SAH patients, multi-center, prospective studies are warranted to verify its efficacy.