gms | German Medical Science

Objective: One reason for early surgery in patients with acutely ruptured aneurysms is the risk of rebleeding, which is highest within the first few days. Re-bleed rates of up to 4% on the first day after subarachnoid hemorrhage (SAH) have been reported. Emotional stress, high blood pressure, CSF drainage and Hunt/Hess (HH) grade are some of the factors believed to be associated with re-rupture. However, larger series addressing this issue are still missing.

Methods: The data from all patients undergoing surgical clipping of an aneurysm were collected in a database. A database search was performed focusing on re-bleeding during the hospital stay prior to surgery. Patients who were admitted later than 3 days after SAH and patients with innocent aneurysms were excluded. The management of the patients was unchanged during the last 15 years with admission to ICU, blood pressure control, CSF drainage if needed (lumbar drainage [LD] in HH <3, ventricular drainage [EVD] in HH 4 and 5) and early operation after angiographic confirmation of the aneurysm.

Results: We identified 505 patients with a single ruptured aneurysm (SIA) and 122 patients with aneurysmal SAH and the angiographic proof of multiple aneurysms (MIA). 11 patients (10 patients with SIA, 1 with MIA) (1.7%) experienced re-bleeding during the hospital stay. In 2 cases of re-bleeding, it was clearly related to insertion of the CSF drainage, 2 re-bleeds occurred during imaging and 1 just prior to the start of the operation. In 5 patients, re-bleeding contributed to a substantial decline in the HH grade. In 4 of the 11 patients the outcome was poor.

Conclusions: We experienced a quite low in-hospital re-bleeding rate, which is possibly related to the presurgical management strategies. A clear relation between CSF drainage and re-bleed could not be found in our series. Re-bleeding contributes to a poorer prognosis.