Perprocedural aneurysm rerupture in relation to timing of endovascular treatment and outcome

The main aim in treatment of aneurysmal subarachnoid haemorrhage (aSAH) is prevention of rebleeding because rebleeding carries a high risk of poor outcome including death. Some studies have advocated ultra-early treatment (<24 hours) of ruptured aneurysms in order to reduce rebleeding and improve clinical outcome.1 The benefit of ultra-early treatment may be more pronounced for coiling than for surgical clipping.1 However, results have been inconsistent and it remains unclear whether ultra-early endovascular treatment improves clinical outcome in patients with aSAH in comparison with treatment within 24–72 hours.2 In a recent meta-analysis, comparison of the outcome after treatment within 24 hours and between 24 and 72 hours showed no clinical benefit of early treatment.2 One study suggested that ultra-early treatment exposes patients to harm.2 A potential risk of aneurysm obliteration within the first hours after rupture is a higher chance of perprocedural aneurysm rupture. We evaluated whether in patients with aSAH, timing of endovascular aneurysm repair is a risk factor for perprocedural aneurysm rupture and whether perprocedural aneurysm re-rupture has any clinical impact. All consecutive patients with aSAH, treated by endovascular coil embolisation at the Radboud University Medical Centre (Nijmegen) and the Academic Medical Centre (Amsterdam) between January 2012 and January 2016, were included. From a prospectively collected database, we retrieved patient characteristics (age and sex), clinical (World Federation of Neurological Surgeons (WFNS) grade) and radiological (Fisher grade, aneurysm …