Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with very high mortality and morbidity. Our limited knowledge on predictors of long-term outcome in poor-grade patients with aSAH definitively managed comes from retrospective and prospective studies of small case series of patients in single center. The purpose of the AMPAS is to determine the long-term outcomes in poor-grade patients with different managements within different time after aSAH, and identify the independent predictors of the outcome that help guide the decision on definitive management. The AMPAS study is a prospective, multicenter, observational registry of consecutive hospitalized patients with poor grade aSAH (WFNS grade IV and V). The aim is to enroll at least 226 poor-grade patients in 11 high-volume medical centers (eg, >150 aSAH cases per year) affiliated to different universities in China. This study will describe poor grade patients and aneurysm characteristics, treatment strategies (modality and time of definitive management), hospitalization complications and outcomes evolve over time. The definitive management is ruptured aneurysm treatment. Outcomes at 3, 6, 12 months after the management were measured using the Glasgow Outcome Scale and the Modified Rankin Scale. The AMPAS is the first prospective, multicenter, observational registry of poor grade aSAH with any management. This study will contribute to a better understanding of significant predictors of outcome in poor grade patients and help guide future treatment of the worst patients after aSAH. Chinese Clinical Trial Registry: ChiCTR-TNRC-10001041 .

Background: Stent-assisted coiling (SAC) is a reasonable treatment for ruptured cerebral aneurysms that are not amenable to primary coiling. However, the safety and efficacy of SAC for acutely ruptured cerebral aneurysms need to be further determined. Purpose: To evaluate the safety and efficacy of SAC for acutely ruptured cerebral aneurysms. Methods: This was a prospective, multicenter study of consecutive patients with acutely ruptured cerebral aneurysms treated with SAC within 72 hours after presentation. The primary outcome was treatment-related thromboembolic complications within 30 days of treatment; the secondary outcomes were hemorrhagic complications and aneurysm recurrence. A favorable clinical outcome was defined as a modified Rankin scale (mRS) of 0 to 2 at 6 months after treatment. Results: Of the 315 patients, 278 patients with 278 acutely ruptured aneurysms were included in the study. Treatment-related thromboembolic complications occurred in 32 patients (11.5%), including nine (3.2%) patients with intraoperative thrombosis and 23 (8.3%) patients with postoperative ischemia. Hemorrhagic complications occurred in 13 (4.7%) patients, including one (0.4%) patient with intraoperative hemorrhage and 12 (4.3%) patients with postoperative hemorrhage. Aneurysm rebleeding occurred in two (0.7%) patients. A total of 251 (251/275, 91.3%) patients had favorable clinical outcomes at the 6-month follow-up. The rate of aneurysm recurrence was 7.2%. Patients with a worse WFNS grade tended to have thromboembolic complications (21.2% vs. 10.2%, P = 0.079) and hemorrhagic complications (12.1% vs. 3.7%, P = 0.054). Treatment-related thromboembolic complications and hemorrhagic complications were independent predictors of unfavorable clinical outcomes. Conclusions: Most patients had favorable clinical outcomes, with a low risk of intraoperative complications, aneurysm rebleeding, and a high rate of aneurysm occlusion. SAC for acutely ruptured aneurysms is a safe and effective procedure, especially in patients with good clinical conditions before treatment.

The systemic coagulation-inflammation (SCI) index reflects both coagulopathic and inflammatory dynamics. We investigated its association with delayed cerebral ischemia (DCI) and functional outcome in aneurysmal subarachnoid hemorrhage (aSAH), explored the mediation effect of DCI within the chain of events, and evaluated the additive predictive value of SCI index. Consecutive aSAH patients were retrospectively analyzed. Multivariate logistic regression examined associations between SCI index, DCI, and poor six‑month outcome. Causal mediation with four‑way decomposition assessed whether DCI mediates the relationship between the SCI index and functional outcome. Finally, the area under the curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the additive value. In total, 583 aSAH patients were included. Among them, DCI occurrence was observed in 133 (23.3%) patients, and functional disability was seen in 177 (30.4%) patients. After adjusting for confounding variables, an elevated SCI index was significantly associated with both DCI and poor outcome. Additionally, the effect of SCI index on poor outcome was partially mediated by DCI, as a mediator that accounted for 23.3% of the positive association. Moreover, adding the SCI index to the predictive model improved the AUC from 0.720 to 0.742, with an NRI and IDI of 3.9 and 2.0%, respectively. The SCI index was associated with poor functional outcomes in aSAH, an effect partially mediated by DCI. Besides, the SCI index slightly improved the outcome prediction after aSAH. However, further studies are necessary to validate our findings and explore the mechanisms.

Background: Traumatic epidural hematoma (EDH) is typically managed surgically when associated with neurological deterioration or significant mass effect. In neurologically intact patients, conservative management or minimally invasive approaches such as middle meningeal artery (MMA) embolization may be considered. The role of periprocedural imaging in guiding endovascular decision-making remains to be clarified. Case presentation: A neurologically intact patient with a left-sided traumatic EDH underwent planned MMA embolization. Immediate preprocedural noncontrast computed tomography (CT) was not performed prior to angiography. Embolization of the left MMA was successfully completed. Postprocedural CT revealed a newly developed contralateral parietal EDH. Repeat angiography confirmed dural arterial supply from the right MMA, and contralateral embolization was performed during the same session. The patient remained clinically stable and did not require surgical evacuation. Follow-up imaging demonstrated stabilization and gradual resolution of both hematomas. Conclusion: We hypothesize that immediate preprocedural CT may aid decision-making for MMA embolization in selected EDH cases, though this single observation requires validation and is not practice-guiding.