Effects of timing of coil embolization after aneurysmal subarachnoid hemorrhage on procedural morbidity and outcomes

OBJECTIVE: To elucidate the effect of treatment timing on procedural clinic al outcomes after aneurysmal subarachnoid hemorrhage (SAH) for patients tre ated by endosaccular coil embolization. METHODS: A group of 327 patients who were consecutively treated, during a 4 6-month period, for ruptured intracranial aneurysms by coil embolization wi thin 30 days after SAH were evaluated. Outcomes were assessed by comparing immediate pretreatment World Federation of Neurological Surgeons (WFNS) gra des, 72-hour posttreatment WFNS grades, and modified Glasgow Outcome Scale scores at 6 months for patients treated within 48 hours (Group 1), 3 to 10 days (Group 2), or 11 to 30 days (Group 3) after SAH. RESULTS: The three interval-to-treatment groups included 33, 38, and 29% of the patients, respectively. Before treatment, 70% of the patients in Group 1, 78% of those in Group 2, and 83% of those in Group 3 were in good clini cal grades (i.e., WFNS Grade 1 or 2). After coil embolization, the WFNS gra des were either unchanged or improved for 93.5% of the patients in Group 1, 89.5% of those in Group 2, and 91.5% of those in Group 3. After 6 months, 81.3% of the patients in Group 1 experienced good outcomes (modified Glasgo w Outcome Scale scores of 1 or 2), as did 84% of those in Group 2 and 80% o f those in Group 3. No statistical difference was demonstrated between the three groups when they were compared for these two variables. CONCLUSION: The interval between endovascular treatment and SAH did not aff ect periprocedural morbidity rates or 6-month outcomes. Coil embolization s hould therefore be performed as early as possible after aneurysmal SAH, to prevent aneurysmal rerupture.