Complicaciones del tratamiento endovascular y quirúrgico en las hemorragias subaracnoideas aneurismáticas en Uruguay: Análisis prospectivo de una serie de 211 casos

Alejandra Jaume; Juan Gil; Mariana Romero; Matías Negrotto; Edgardo Spagnuolo

doi:10.29193/RMU.39.4.1

Authors

Alejandra Jaume Administración de los Servicios de Salud del Estado, Hospital Maciel, Servicio de Neurocirugía https://orcid.org/0000-0003-2258-5372
Juan Gil Universidad de la República, Facultad de Medicina, Departamento de Métodos Cuantitativos https://orcid.org/0000-0002-4704-185X
Mariana Romero Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Neurocirugía https://orcid.org/0009-0005-8011-9654
Matías Negrotto Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Imagenología https://orcid.org/0000-0002-7512-4943
Edgardo Spagnuolo Administración de los Servicios de Salud del Estado, Hospital Maciel, Servicio de Neurocirugía https://orcid.org/0009-0003-9845-1415

DOI:

https://doi.org/10.29193/RMU.39.4.1

Keywords:

SUBARACHNOID HEMORRHAGE, ANEURYSM, SURGERY, ENDOVASCULAR TREATMENT

Abstract

Introduction: While several studies have addressed the comparison between endovascular treatment and surgical clipping of ruptured aneurysms, there is still no definitive evidence regarding the use of one or the other in terms of safety and improved prognosis. The objective of this study is to analyze the various modalities of subarachnoid hemorrhage (SAH) treatment implemented in Uruguay and their impact on aneurysm resolution and patient prognosis.
Method: This is a prospective, multicenter study that includes all patients over 18 years of age who were treated for spontaneous aneurysmal subarachnoid hemorrhage in Uruguay between November 1, 2019, and October 31, 2020. We collected and examined clinical-epidemiological characteristics and comorbidities at the time of diagnosis, the type of treatment received, and clinical outcome variables over the following 6 months. The data were analysed using the Statistical Package for Social Sciences (SPSS) software, and a significance level of 5% was applied in the tests. Due to the multicenter and national nature of the study, it had to be submitted for evaluation to all the Ethics Committees of the participating healthcare institutions.
Results: A total of 211 cases were observed during the evaluated period. The mean age was 57 years with a predominance of females (75%). In 74% of the cases, some form of specific treatment was recommended (43% open surgery and 31% endovascular therapy), while the remaining patients could not undergo aneurysm treatment due to their severe neurological condition. 52 patients experienced complications related to the treatment received, with a higher proportion of these in the case of open surgery compared to endovascular therapy (42% vs. 21,5%; p=0,008).
Conclusions: A higher rate of complications was observed in the surgical treatment, with no impact on morbidity and mortality. Among the independent predictors of poor clinical outcomes identified, the only one related to the type of treatment was the presence of extensive ischemia.

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