{
  "abstract": "Background Current guidelines recommend early aneurysm securing after aneurysmal subarachnoid hemorrhage (aSAH), ideally within the first 24 hours, to reduce the risk of rebleeding. However, high-quality comparative data evaluating outcomes of treatment within 24 hours versus 24-72 hours remain limited. We aimed to compare mortality, functional outcomes, and major complications between these treatment windows in a large multicenter cohort.Methods We performed a retrospective cohort study using the TriNetX Research Network, including 111 healthcare organizations in the United States, to identify adults with aSAH (ICD-10-CM I60.0-I60.7) who underwent aneurysm treatment between January 2016 and January 2026. Patients were stratified by treatment timing (<24 hours vs 24-72 hours) and further analyzed by treatment modality, including endovascular treatment (EVT) and surgical clipping. Patients with arterial dissection, arteriovenous malformation, or Moyamoya disease were excluded. Propensity score matching (1:1) was performed separately within each treatment subgroup to balance demographics, comorbidities, and baseline clinical characteristics. Primary outcomes included all-cause mortality and functional dependency at 3 months, 6 months, 1 year, and 2 years. Secondary outcomes included cerebral ischemia, hydrocephalus, seizures, prolonged ICU stay, and stress ulcer bleeding. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and Kaplan-Meier survival analysis with log-rank testing was performed.Results Before matching, the EVT cohort included 9,275 patients treated within 24 hours and 4,781 treated within 24-72 hours; after matching, 4,780 patients remained in each group. The clipping cohort included 1,874 patients treated within 24 hours and 1,195 treated within 24-72 hours; after matching, 1,192 patients remained in each group. In the EVT subgroup, 3-month mortality was similar between early and intermediate treatment groups (13.08% vs 13.20%; HR 0.99, 95% CI 0.89-1.11, p=0.86), as was functional dependency (15.91% vs 15.84%; HR 1.00, 95% CI 0.90-1.12, p=0.99). Cerebral ischemia (11.36% vs 10.86%; HR 1.05, 95% CI 0.91-1.21, p=0.51), hydrocephalus (6.47% vs 6.92%; HR 0.93, 95% CI 0.73-1.19, p=0.58), and seizures (5.30% vs 5.30%; HR 1.00, 95% CI 0.82-1.21, p=0.98) were also comparable. At 2 years, mortality remained similar (16.05% vs 16.13%; HR 0.99, 95% CI 0.90-1.10, p=0.89), as did functional dependency (17.98% vs 17.72%; HR 1.01, 95% CI 0.91-1.12, p=0.84). In the clipping subgroup, 3-month mortality was likewise similar (10.07% vs 10.49%; HR 0.96, 95% CI 0.75-1.24, p=0.76), as was functional dependency (18.74% vs 19.55%; HR 0.95, 95% CI 0.78-1.17, p=0.65). No significant differences were observed for cerebral ischemia, hydrocephalus, seizures, or long-term outcomes through 2 years in either treatment modality. Kaplan-Meier analysis demonstrated no significant survival differences between groups.Conclusion In this large propensity score-matched multicenter analysis, aneurysm treatment within 24 hours of aSAH was associated with outcomes comparable to treatment within 24-72 hours, both overall and across endovascular and surgical treatment subgroups. Mortality, functional dependency, and major complications did not differ significantly through 2 years of follow-up. These findings suggest that although early treatment remains appropriate when feasible, treatment within 24-72 hours may be an acceptable alternative when clinically necessary without compromising outcomes.Disclosures M. Essibayi: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "M Essibayi"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Altschul"
    },
    {
      "affiliations": [
        "Neuroradiology, West Virginia University, Morgantown, WV"
      ],
      "name": "D Lakhani"
    }
  ],
  "title": "E-336 Aneurysm treatment within 24 hours versus 24-72 hours after aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis of short- and long-term outcomes",
  "uid": "9d789b28-be2c-58ee-a1d8-ac8c09605166"
}