BACKGROUND: Endovascular coiling (EVC) has been shown to yield superior clinical outcomes to surgical clipping (SC) in the treatment of @entity1756 . The reasons for these differences remain obscure. We aimed to assess outcomes of EVC and SC relative to baseline physiological derangement. METHODS: This was an exploratory analysis of prospectively collected trial data. Physiological derangement was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Other contributory variables such as age, World Federation of Neurosurgical Societies (WFNS) grade, and development of complications, including @entity1276 and @entity2553 , were included in the analysis. Clinical outcome was independently assessed at 90   days using the modified Rankin Scale (mRS). Hospital stay, ventilated days, and total @entity1063 dose were also used as secondary outcomes. Multivariate analysis was performed using binary logistic regression. RESULTS: EVC was performed in 69 @entity1 and SC in 66 @entity1 . More profound physiological derangement (APACHE II score >15) was the strongest predictor of poor outcome in the overall cohort (OR 17.80, 95% CI 4.78 to 66.21, p<0.0001). For those with more deranged physiology (APACHE II score>15; 59 @entity1 ), WFNS grade >= 4 (OR 6.74, 1.43 to 31.75) and SC (OR 6.33, 1.27 to 31.38) were significant predictors of poor outcome (p<0.05). Favorable outcome (mRS 0-2) was seen in 11% of SC @entity1 compared with 38% of EVC @entity1 in this subgroup. SC @entity1 had significantly increased total @entity1063 dose, ventilated days, and hospital stay (p<0.05). CONCLUSIONS: More profound physiological derangement at baseline is a strong predictor of eventual poor outcome, and outcomes for @entity1 with more profound baseline physiological derangement may be improved if undergoing a coiling procedure.

Short term outcomes following clipping and coiling of XXXX : does some of the benefit of coiling stem from less procedural impact on deranged physiology at presentation?

@entity1 :: ('9606', 'Species') :: ['patients'] @entity1276 :: ('MESH:D006849', 'Disease') :: ['hydrocephalus'] @entity2553 :: ('MESH:D020301', 'Disease') :: ['vasospasm'] @entity1063 :: ('MESH:D009638', 'Chemical') :: ['norepinephrine'] @entity1756 :: ('MESH:D017542', 'Disease') :: ['ruptured cerebral aneurysms']
@entity1756 :: (MESH:D017542,Disease) :: ['ruptured intracranial aneurysms']
