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- Title
Sex differences in patients with and without high-risk factors associated with aneurysmal subarachnoid hemorrhage.
- Authors
Catapano, Joshua S.; Winkler, Ethan A.; Rudy, Robert F.; Graffeo, Christopher S.; Koester, Stefan W.; Srinivasan, Visish M.; Cole, Tyler S.; Baranoski, Jacob F.; Scherschinski, Lea; Jha, Ruchira M.; Jadhav, Ashutosh P.; Ducruet, Andrew F.; Albuquerque, Felipe C.; Lawton, Michael T.
- Abstract
Background: Controversy remains regarding the appropriate screening for intracranial aneurysms or for the treatment of aneurysmal subarachnoid hemorrhage (aSAH) for patients without known high-risk factors for rupture. This study aimed to assess how sex affects both aSAH presentation and outcomes for aSAH treatment. Method: A retrospective cohort study was conducted of all patients treated at a single institution for an aSAH during a 12-year period (August 1, 2007–July 31, 2019). An analysis of women with and without high-risk factors was performed, including a propensity adjustment for a poor neurologic outcome (modified Rankin Scale [mRS] score > 2) at follow-up. Results: Data from 1014 patients were analyzed (69% [n = 703] women). Women were significantly older than men (mean ± SD, 56.6 ± 14.1 years vs 53.4 ± 14.2 years, p < 0.001). A significantly lower percentage of women than men had a history of tobacco use (36.6% [n = 257] vs 46% [n = 143], p = 0.005). A significantly higher percentage of women than men had no high-risk factors for aSAH (10% [n = 70] vs 5% [n = 16], p = 0.01). The percentage of women with an mRS score > 2 at the last follow-up was significantly lower among those without high-risk factors (34%, 24/70) versus those with high-risk factors (53%, 334/633) (p = 0.004). Subsequent propensity-adjusted analysis (adjusted for age, Hunt and Hess grade, and Fisher grade) found no statistically significant difference in the odds of a poor outcome for women with or without high-risk factors for aSAH (OR = 0.7, 95% CI = 0.4–1.2, p = 0.18). Conclusions: A higher percentage of women versus men with aSAH had no known high-risk factors for rupture, supporting more aggressive screening and management of women with unruptured aneurysms.
- Subjects
SUBARACHNOID hemorrhage; INTRACRANIAL aneurysms; OLDER men; TOBACCO use; MEDICAL screening
- Publication
Acta Neurochirurgica, 2024, Vol 166, Issue 1, p1
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-024-06021-1