• Pietro Panni, Lucia Riccio, Roberta Cao, Alessandro Pedicelli, Enrico Marchese, Anselmo Caricato, Alberto Feletti, Mattia Testa, Paolo Zanatta, Nicola Gitti, Simone Piva, Dikran Mardighian, Vittorio Semeraro, Giordano Nardin, Emilio Lozupone, Giafranco Paiano, Edoardo Picetti, Vito Montanaro, Massimo Petranca, Carlo Bortolotti, Antonino Scibilia, Luigi Cirillo, Andrea Luigi Lanterna, Alessandro Ambrosi, Pietro Mortini, Luigi Beretta, and Andrea Falini.
• Department of Neuroradiology, Interventional Neuroradiology Division, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
• Neurosurgery. 2023 Sep 1; 93 (3): 636645636-645.

BackgroundScarce data are available regarding rebleeding predictors in poor-grade aneurysmal subarachnoid hemorrhage (aSAH).ObjectivesTo investigate predictors and clinical impact of rebleeding in a national multicentric poor-grade aSAH.MethodsRetrospective analysis of prospectively collected data from the multicentric Poor Grade Aneurysmal Subarachnoid Hemorrhage Study Group (POGASH) registry of consecutive patients treated from January 1, 2015, to June 30th, 2021. Grading was defined as pretreatment World Federation of Neurological Surgeons grading scale IV-V. Ultra-early vasospasm (UEV) was defined as luminal narrowing of intracranial arteries not due to intrinsic disease. Rebleeding was defined as clinical deterioration with evidence of increased hemorrhage on subsequent computed tomography scans, fresh blood from the external ventricular drain, or deterioration before neuroradiological evaluation. Outcome was assessed by the modified Rankin Scale.ResultsAmong 443 consecutive World Federation of Neurological Surgeons grades IV-V patients with aSAH treated within a median of 5 (IQR 4-9) hours since onset, rebleeding occurred in 78 (17.6%). UEV (adjusted odds ratio [OR] 6.8, 95% CI 3.2-14.4; P < .001) and presence of dissecting aneurysm (adjusted OR 3.5, 95% CI 1.3-9.3; P = .011) independently predicted rebleeding while history of hypertension (adjusted OR 0.4, 95% CI 0.2-0.8; P = .011) independently reduced its chances. 143 (32.3) patients died during hospitalization. Rebleeding emerged, among others, as an independent predictor of intrahospital mortality (adjusted OR 2.2, 95% CI 1.2-4.1; P = .009).ConclusionUEV and presence of dissecting aneurysms are the strongest predictors of aneurysmal rebleeding. Their presence should be carefully evaluated in the acute management of poor-grade aSAH.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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