Predictors of poor functional outcome after endovascular treatment in patients with poor-grade aneurysmal subarachnoid hemorrhage

Objective: Endovascular treatment (EVT) is considered an effective treatment for patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Although the prognosis of these patients seems to have improved in recent years, it is generally still considered poor. We analyzed our data to determine potential predictors of poor prognosis in these patients. Methods: We retrospectively analyzed data from patients with poor-grade aSAH who underwent EVT at our institution between November 2018 and June 2023. The data included patient baseline clinical characteristics, treatment modalities, imaging features, postoperative complications, and functional neurological outcomes. At six months, outcomes were assessed using the modified Rankin scale (mRS) and dichotomized into good (mRS 0-2) and poor (mRS 3-6) groups. Multivariate analysis was performed to identify predictors of outcome, and the discriminative ability of the model was assessed using the area under the receiver operating characteristic curve (ROC). Results: The study included 117 poor-grade aSAH patients who underwent EVT. Fifty-eight (49.6 %) patients had poor outcomes. Univariate analysis suggested that older age (p = 0.003), higher Hunt-Hess (H-H) grade (15.3 % vs. 46.6 %, p < 0.001), posterior circulation aneurysms (15.3 % vs.31.0 %, p = 0.050)hydrocephalus (39.0 % vs. 63.8 %, p = 0.010), intraventricular hematoma (IVH) (69.5 % vs. 87.9 %, p = 0.023), ventricular casting (8.5 % vs. 43.1 %, p < 0.001), and external ventricular drainage (EVD) (44.1 % vs. 77.6 %, p <0.001) were associated with poor outcomes. Multivariate analysis revealed that older age, higher H-H grade, and ventricular casting were predictors of poor outcomes with good discriminative ability (ROC=0.81, 95 % CI 0.73-0.89; p < 0.001). Conclusions: Older age, higher H-H grade, and ventricular casting are associated with poor outcomes in patients with poor-grade aSAH. In this study, 50.4 % of patients achieved good outcomes, suggesting that early individualized treatment should be aggressively pursued for poor-grade aSAH patients to avoid rebleeding from ruptured aneurysms and potentially poor outcomes.