PT  - JOURNAL ARTICLE
AU  - Mitra, D.
AU  - Gregson, B.
AU  - Jayakrishnan, V.
AU  - Gholkar, A.
AU  - Vincent, A.
AU  - White, P.
AU  - Mitchell, P.
TI  - Treatment of Poor-Grade Subarachnoid Hemorrhage Trial
AID  - 10.3174/ajnr.A4061
DP  - 2015 Jan 01
TA  - American Journal of Neuroradiology
PG  - 116--120
VI  - 36
IP  - 1
4099  - http://www.ajnr.org/content/36/1/116.short
4100  - http://www.ajnr.org/content/36/1/116.full
SO  - Am. J. Neuroradiol.2015 Jan 01; 36
AB  - BACKGROUND AND PURPOSE: Management of poor-grade subarachnoid hemorrhage is based on limited evidence from small single-center retrospective observational studies. The purpose of this study was to undertake a single-center randomized controlled feasibility trial comparing a strategy of early endovascular aneurysm treatment with treatment after neurologic recovery in this group of patients. MATERIALS AND METHODS: Patients with poor-grade SAH were randomized within 24 hours of admission to early treatment or treatment after neurologic recovery. If a patient was randomized to early treatment, the aneurysm was treated endovascularly within 24 hours of randomization. Recruitment rate, safety profile, and functional outcome at the time of discharge and at 6 months were assessed. RESULTS: Fourteen of 51 patients screened were eligible for the trial. Of these 14, 8 patients were randomized (57%). All patients in the early coiling arm received treatment within 24 hours of randomization. There was no treatment-related complication. Overall, good outcome occurred in 25% of patients; the mortality rate was 75%. Patients in the early treatment arm (n = 5) had a good outcome rate of 20%, while those in treatment after neurologic recovery arm (n = 3) had a good outcome rate of 33.3%. CONCLUSIONS: This was a feasibility study that demonstrated that recruitment and randomization for comparing management strategies in poor-grade SAH are feasible. The recruitment rate among eligible patients was encouraging (57%), though a number of patients had to be excluded due to ineligibility. A multicenter study is necessary to recruit the numbers required to compare the clinical outcomes of these management strategies. ISATInternational Subarachnoid Aneurysm TrialWFNSWorld Federation of Neurosurgical Societies