动脉瘤性蛛网膜下腔出血血管内治疗院内结局的影响因素OA

Objective To analyze factors associated with in-hospital outcomes in patients with aneurysmal subarachnoid hemorrhage(aSAH)who underwent endovascular treatment,with particular emphasis on the association between rupture-to-puncture time(RPT)and in-hospital outcomes. Methods Patients with aSAH who underwent endovascular treatment at the Department of Neurosurgery,the Affiliated Hospital of Guizhou Medical University between January 2014 and December 2023 were retrospectively included.Patients were divided into the RPT≤6 h group and the RPT>6 h group.Baseline clinical and imaging characteristics,in-hospital outcomes,and complications were compared between the two groups.Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality,and propensity score matching and overlap weighting were performed as sensitivity analyses. Results A total of 1053 patients with aSAH were included,with a median age of 55(48-63)years,of whom 474(45％)were male.41 patients were in the RPT≤6 h group and 1012 patients were in the RPT>6 h group.Compared with the RPT>6 h group,the RPT≤6 h group had lower admission GCS scores(P<0.001),a lower proportion of patients with a discharge mRS score of 0-2(P<0.001),and a lower rate of dense embolization(P=0.029),whereas the proportions of Hunt-Hess grade Ⅳ-Ⅴ and modified Fisher grade 3-4 were higher,and the in-hospital mortality rate was higher(all P<0.001).Multivariable logistic regression analysis showed that Hunt-Hess grade Ⅳ-Ⅴ(OR 6.00,95％CI 2.96-12.17,P<0.001),modified Fisher grade 3-4(OR 2.36,95％CI 1.21-4.60,P=0.012),each 1-year increase in age(OR 1.03,95％CI 1.01-1.06,P=0.020),and RPT≤6 h(OR 5.26,95％CI 2.23-12.42,P<0.001)were independent risk factors for in-hospital mortality.After propensity score matching,compared with RPT>6 h,RPT≤6 h remained associated with in-hospital mortality(P=0.026).Overlap weighting analysis showed that,compared with RPT>6 h,RPT≤6 h remained associated with in-hospital mortality(P=0.007),whereas no statistically significant differences were found for the remaining variables. Conclusions In-hospital mortality in patients with aSAH undergoing endovascular treatment is associated with age,clinical disease severity,radiographic hemorrhage burden,and RPT.Patients with RPT≤6 h are predominantly critically ill and at high risk.RPT may serve as an indicator for evaluating the timeliness of the treatment pathway,but assessment of in-hospital outcomes should not rely on RPT alone and should also incorporate clinical and radiographic severity.