Textbook Outcomes Among Patients with Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment.

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2024-04-01 Epub Date: 2024-01-23 DOI:10.1007/s40120-024-00577-x

Zisheng Liu, Yuhao Tan, Yanpeng Wei, Dongwei Dai, Rui Zhao, Qiang Li, Qinghai Huang, Yi Xu, Pengfei Yang, Jun Sun, Jianmin Liu, Qiao Zuo

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引用次数: 0

Abstract

Introduction: The case fatality rate among patients with aneurysmal subarachnoid hemorrhage (aSAH) has decreased progressively, with numerous patients subjected to contemporary paradigms that minimize the use of agonizing therapeutic processes. The concept of the "Textbook Outcome" (TO), a composite outcome that highlights numerous favorable outcomes, was developed in the context of gastrointestinal tumor surgeries and expeditiously extended across diverse surgical spheres. The aim of this study was to explore the factors hindering the achievement of optimal prognoses in postinterventional aSAH patients, employ textbook outcomes, and establish predictive models.

Methods: We conducted a retrospective review of data from 1270 aSAH patients who received endovascular treatment between 2012 and 2018. We delineated an exemplary TO within the aSAH domain, characterized by favorable clinical results, minimal complications, and the absence of retreatments. This TO-oriented approach is explained within the manuscript.

Results: The findings revealed that preoperative intraventricular hemorrhage (IVH), preoperative Hunt and Hess grade (H&H) ≥ 3, World Federation of Neurosurgical Societies (WFNS) grade ≥ 3, the presence of blebs on the aneurysm, aneurysms situated at branching sites, and non-stent-assisted endovascular intervention were the strongest risk factors for not achieving textbook outcomes (non-"Textbook Outcome" [N-TO]). Decision curve analysis and calibration analyses revealed strong concordance between the predictions of the N-TO nomogram model and the actual observations.

Conclusions: Treatment Outcomes hold significant practical value in clinical studies of aSAH patients receiving endovascular treatment. The likelihood of N-TOs was predicted by IVH, H&H grade ≥ 3, WFNS grade ≥ 2, presence o f bleb on the aneurysm, and aneurysms located at branching sites.

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动脉瘤性蛛网膜下腔出血患者接受血管内治疗后的教科书式疗效。

导言：动脉瘤性蛛网膜下腔出血（aSAH）患者的病死率已逐步下降，许多患者接受了当代范例，最大限度地减少了痛苦治疗过程的使用。教科书结果"（TO）的概念是一种强调多种有利结果的综合结果，它是在胃肠道肿瘤手术的背景下提出的，并迅速推广到不同的外科领域。本研究旨在探讨阻碍介入手术后 aSAH 患者获得最佳预后的因素，采用教科书结果并建立预测模型：我们对 2012 年至 2018 年间接受血管内治疗的 1270 例 aSAH 患者的数据进行了回顾性审查。我们划定了 aSAH 领域中的 TO 范例，其特点是临床效果良好、并发症极少、无再治疗。手稿中解释了这种以 TO 为导向的方法：结果：研究结果显示，术前脑室内出血（IVH）、术前Hunt和Hess分级（H&H）≥3、世界神经外科学会联合会（WFNS）分级≥3、动脉瘤上存在出血点、动脉瘤位于分支部位以及非辅助血管内介入治疗是无法实现教科书结果（非 "教科书结果"[N-TO]）的最主要风险因素。决策曲线分析和校准分析表明，N-TO提名图模型的预测结果与实际观察结果非常吻合：结论：治疗结果对接受血管内治疗的 ASAH 患者的临床研究具有重要的实用价值。IVH、H&H 分级≥3、WFNS 分级≥2、动脉瘤上有出血栓和动脉瘤位于分支部位均可预测 N-TO 的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. 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