Timing of aneurysm repair and clinical outcomes after aneurysmal subarachnoid hemorrhage: a systematic review.
Táya Figueiredo de Oliveira Fiore, Ângela Maria Arantes Vieira, Fábio de Freitas Magalhães et al.
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In 30 seconds
This systematic review examined the relationship between timing of aneurysm repair and clinical outcomes in adults with aneurysmal subarachnoid hemorrhage (aSAH). Analyzing 20 studies with 11,096 participants, the review found that earlier treatment likely reduced pretreatment rebleeding, but no consistent independent association was established between treatment timing and mortality or functional outcomes. The evidence quality was very low.
Key findings
- Earlier securement likely reduced pretreatment rebleeding, especially in untreated or delayed patients.
- No reproducible independent association was found between treatment timing and functional outcome or mortality.
- Mortality patterns suggested a U-shaped association with an estimated nadir at 32.6 hours.
- Certainty of evidence for the timing-mortality association was very low due to bias and inconsistency.
Why it matters
Understanding the optimal timing for aneurysm repair in aSAH is crucial for improving patient outcomes. This review highlights the complexities and uncertainties surrounding treatment timing, which can inform clinical decision-making and guideline adherence.