Endovascular Treatment for Ruptured intracranial Aneurysm With Intracerebral Hematoma - Clinical Propriety of Less Invasive treatment.

BACKGROUND: Endovascular treatment for ruptured intracranial aneurysms (rIA) accompanied by intracerebral hematoma (ICH) can be challenging because ICH may be enlarged due to intraoperative anticoagulation during the endovascular procedure. This retrospective study aimed to compare the outcomes of aneurysmal subarachnoid hemorrhage (SAH) with and without ICH treated by endovascular procedures.

METHODS: We reviewed 62 cases who underwent endovascular treatment for rIA between January 2015 and April 2023. The subjects were divided into two groups: those with ICH (group H, n=13) and those without ICH (group N, n=49). Patient demographics, aneurysm characteristics, World Federation of Neurosurgical Societies (WFNS) grade, complications (e.g., symptomatic vasospasm, hydrocephalus), and outcomes were assessed with the presence or absence of ICH. In group H, age, sex, complications, WFNS grade, and hematoma volume were also analyzed in relation to outcomes at discharge.

RESULTS: None of these cases required removal of ICH after endovascular treatment for rIA. There were no significant differences in patient characteristics, aneurysm morphologies, WFNS grade, or overall outcome between the two groups. Conversely, only poor WFNS grade was significantly associated with poor outcome (modified Rankin Scale ≥ 3) in group H (p=0.04), and ICH volume was not significantly different between good (6.2 ± 5.8 cc) and poor (14.6 ± 10.4 cc) outcomes in group H (p=0.20).

CONCLUSION: Endovascular treatment without hematoma evacuation did not adversely affect the outcomes of rIA with ICH when the clinical condition and aneurysm morphology permit. Surgical invasion might be avoidable with this less invasive strategy without worsening the outcomes.