Outcome after endovascular treatment of hunt and hess grade IV or V aneurysms - Comparison of anterior versus posterior circulation

Background and Purpose-The most common cause of poor treatment outcome in p atients suffering aneurysmal subarachnoid hemorrhage is cerebral vasospasm, especially in cases of poor Hunt and Hess grades (IV and V), A further pro gnostic factor in surgically treated patients is aneurysm localization. The aim of the present retrospective study is to compare the endovascular trea tment outcome in such poor-grade patients according to aneurysm localizatio n in either the anterior (AC) or posterior (PC) circulation. Methods-Forty poor-grade patients admitted between 1993 and July 1998 were treated by endovascular approach within 23 days after aneurysm rupture, Eig hteen had aneurysms in the AC, 22 in the PC. Mean treatment delay was 4 day s after rupture and median, 2 days. One patient showed multiple aneurysms. In 36 cases, aneurysms were occluded by Guglielmi detachable coils; in 4 ca ses, by parent vessel balloon occlusion, Results-The incidence of delayed ischemic neurological dysfunction or cereb ral infarct due to vasospasm did not differ significantly between the AC an d PC groups. Two procedure-related complications with clinical effect were observed in each group. At 6 months' follow-up, the result was good in 5 pa tients and poor in 13 in the AC group and good in Il patients and poor in 1 1 in the PC group. Conclusions-Given comparable incidence of vasospasm in poor-grade patients, a tendency toward better treatment outcome was found in patients with aneu rysms in the posterior circulation (chi(2)=2.04; P=0.15) than in the anteri or circulation. Endovascular therapy for poor-grade patients is recommended , as are further studies to determine treatment differences.