Biomedical subjects

Afshin A Divani

Publications and source records attributed to Afshin A Divani.

At least 19 recordsLinked to original sources

PubMed2007

Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States.

PURPOSE: The aim of this study was to estimate the prevalence of elevated blood pressure in adult patients with acute stroke in the United States (US). METHODS: Patients with stroke were classified by initial systolic blood pressure (SBP) into 4 categories using demographic, clinical, and treatment data from the National Hospital Ambulatory Medical Care Survey, the largest study of use and provision of emergency department (ED) services in the United States. We also compared the age-, sex-, and ethnicity-adjusted rates of elevated blood pressure strata, comparable with stages 1 and 2 hypertension in the US population. RESULTS: Of the 563704 patients with stroke evaluated, initial SBP was below 140 mm Hg in 173120 patients (31%), 140 to 184 mm Hg in 315207 (56%), 185 to 219 mm Hg in 74586 (13%), and 220 mm Hg or higher in 791 (0.1%). The mean time interval between presentation and evaluation was 40 +/- 55, 33 +/- 39, 25 +/- 27, and 5 +/- 1 minutes for increasing SBP strata (P = .009). A 3- and 8-fold higher rate of elevated blood pressure strata was observed in acute stroke than the existing rates of stages 1 and 2 hypertension in the US population. Labetalol and hydralazine were used in 6126 (1%) and 2262 (0.4%) patients, respectively. Thrombolytics were used in 1283 patients (0.4%), but only in those with SBP of 140 to 184 mm Hg. CONCLUSIONS: In a nationally representative large data set, elevated blood pressure was observed in over 60% of the patients presenting with stroke to the ED. Elevated blood pressure was associated with an earlier evaluation; however, the use of thrombolytics was restricted to patients with ischemic stroke with SBP below 185 mm Hg.

Adult↗

PubMed2006

Regular egg consumption does not increase the risk of stroke and cardiovascular diseases.

BACKGROUND: We performed this study to examine the association between egg consumption and risk of cardiovascular diseases and mortality in a nationally representative cohort of 9734 adults aged 25 to 74 years. MATERIAL/METHODS: Egg consumption was categorized into no or less than 1 egg, 1 to 6 eggs, or greater than 6 eggs per week. Cox proportional hazards analysis was used to identify the relative risk (RR) of incident stroke, ischemic stroke, coronary artery disease and mortality over a 20-year follow-up in all participants and subsequently in diabetic participants. RESULTS: After adjusting for differences in age, gender, race, serum cholesterol level, body mass index, diabetes mellitus, systolic blood pressure, educational status and cigarette smoking, no significant difference was observed between persons who consumed greater than 6 eggs per week compared to those who consume none or less than 1 egg per week in regards to any stroke (RR, 0.9; 95% confidence interval (CI), 0.7 to 1.1), ischemic stroke (RR, 0.9; 95% CI, 0.7 to 1.1), or coronary artery disease (RR, 1.1; 95% CI, 0.9 to 1.3). In subgroup analysis among diabetics, consumption of greater than 6 eggs per week was associated with an increased risk of coronary artery disease (RR 2.0, 95% CI 1.0-3.8). CONCLUSIONS: Consumption of greater than 6 eggs per week (average of 1 egg or greater per day) does not increase the risk of stroke and ischemic stroke. The increased risk of coronary artery disease associated with higher egg consumption among diabetics warrants further investigations.

Adult↗

PubMed2006

Free thyroxine index and risk of stroke: results from the National Health and Nutrition Examination Survey Follow-up Study.

BACKGROUND: The long-term risks of stroke associated with hypothyroidism and hyperthyroidism is unknown. We evaluated the long-term risk of stroke with hypothyroidism and hyperthyroidism compared with euthyroid status. MATERIAL/METHODS: We used the 20-year follow-up data for adults aged 25 to 74 years who participated in the First National Health and Nutrition Examination Survey Follow-up Study. Hypothyroidism or hyperthyroidism was diagnosed by free thyroxine index measurements at baseline evaluation and incident events were determined from hospital records and death certificates during follow-up. Relative risk (RR) of stroke, ischemic stroke, and intracerebral hemorrhage for each category of thyroid function were determined by Cox proportional hazards analysis after adjustment for potential confounding variables. RESULTS: A total of 5,269 participants (mean age 48+/-14 years; 2,379 men) were evaluated. Hypothyroidism and hyperthyroidism were diagnosed in 493 (9.4%) and 34 (0.7%) participants, respectively. After adjustment for covariates, a significantly higher RR for all strokes and for ischemic stroke was observed in participants with hypothyroidism (RR 1.6; 95% confidence interval (CI), 1.0-2.6 and RR 1.6, 95% CI, 1.0-2.7, respectively). Hyperthyroidism was not associated with an increased risk for stroke. CONCLUSIONS: An increased risk for stroke (particularly ischemic stroke) was observed in patients with hypothyroidism.

Adult↗

PubMed2006

African American women have poor long-term survival following ischemic stroke.

OBJECTIVE: To determine racial and gender differences in long-term survival following ischemic stroke in a well-defined cohort of patients. METHODS: We analyzed the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. We determined the effect of race and gender on 1-year survival ascertained by serial follow-ups using Kaplan-Meier analysis. Multivariate analysis was performed adjusting for age, initial NIH Stroke Scale (NIHSS) score, use of thrombolysis, time to randomization, stroke etiology, and other cardiovascular risk factors. RESULTS: Of the 547 patients with ischemic stroke, the 1-year survival (percentage +/- SE) for African American women (63 +/- 6%) was lower than white women (73 +/- 4%), African American men (79 +/- 4%), and white men (75 +/- 3%). Among the 209 patients younger than 65 years, the 1-year survival was prominently lower for African American women (66 +/- 8%) vs white women (87 +/- 5%), African American men (83 +/- 5%), and white men (89 +/- 3%). In the Cox proportional hazard analysis, African American women had a significantly higher rate of 1-year mortality (relative risk 2.1, 95% CI 1.2 to 3.5) after adjusting for all potential confounders except diabetes mellitus. After adjustment for diabetes mellitus, the difference became insignificant, although a 70% greater risk of 1-year mortality was still observed. CONCLUSIONS: Compared with whites and men, African American women have a lower 1-year survival following ischemic stroke.

Adult↗

PubMed2006

Treatment of acute hypertension in patients with intracerebral hemorrhage using American Heart Association guidelines.

OBJECTIVE: To determine the feasibility and safety of treatment of acute hypertension in patients with intracerebral hemorrhage within 24 hrs of symptom onset. Elevated blood pressure, observed in up to 56% of patients with intracerebral hemorrhage, may predispose to hematoma expansion; on the other hand, reduction of blood pressure may reduce hematoma expansion and subsequent death and disability. DESIGN: Single-center prospective registry supplemented by retrospective chart review. SETTINGS: University-affiliated medical center with dedicated stroke service. PATIENTS: All patients admitted to the stroke service with spontaneous intracerebral hemorrhage and acute hypertension within 24 hrs of symptom onset. INTERVENTION: Patients were treated with intravenous nicardipine within 24 hrs of symptom onset to reduce and maintain mean arterial pressure of <130 mm Hg. The mean arterial pressure goal was consistent with the American Heart Association guidelines. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the tolerability of the treatment as assessed by achieving and maintaining the mean arterial pressure goals for 24 hrs after initiation of intravenous nicardipine infusion. Other end points ascertained were: neurologic deterioration defined by a decline in Glasgow Coma Scale from pretreatment assessment by >or=2 points or increase in National Institutes of Health Stroke Scale score by >or=2 points and hemorrhage growth defined as an increase in the volume of intraparenchymal hemorrhage of >33% as measured by image analysis on the 24-hr computed tomographic scan compared with the baseline computed tomographic scan. Rates of favorable outcome and death were ascertained at 1 month. Of the total 46 patients admitted with intracerebral hemorrhage in our service, 29 patients were treated. Mean age of the treated patients was 58 +/- 13 yrs; ten were women. Initial National Institutes of Health Stroke Scale ranged from 1 to 38. The primary outcome of tolerability was achieved in 25 of the 29 patients (86%). Neurologic deterioration was observed in 4 of 29 patients. Hematoma enlargement was observed in five patients. Favorable outcome (defined as modified Rankin scale of <or=2) and death at 1-month was observed in 11 (38%) and 9 (31%) of the 29 patients, respectively. CONCLUSIONS: We observed a high rate of tolerability among patients with intracerebral hemorrhage who were treated with intravenous nicardipine using mean arterial pressure goals defined by American Heart Association guidelines within 24 hrs of symptom onset.

Adult↗

PubMed2006

Primary stroke center: basic components and recommendations.

Stroke is the leading cause of disability and the third leading cause of death in the United States. The brain attack coalition (BAC), whose members belong to several professional medical societies, formed a working group to explore the factors and elements that are associated with better clinical outcome after acute stroke. In the year 2000, the BAC published the recommendations for primary stroke centers (PSC). The primary goals for the PSC are to improve and to standardize stroke care. Convinced by the compelling data on the PSC, the Joint Commission on Accreditation of Healthcare Organization adopted the BAC recommendations and started certifying hospitals as designated PSCs. Many hospitals are already certified and numerous others are currently seeking certification. The BAC is now working on the recommendations for a comprehensive stroke center. The nihilism which dominated the stroke field has finally been replaced by remarkable progress and better understanding of stroke and stroke treatment.

Clinical Protocols↗

PubMed2006

Comparison of asymmetry in cerebral blood flow between brain hemispheres using digital subtraction angiography.

BACKGROUND AND PURPOSE: Recently, endovascular techniques have gained significant therapeutic potential for both treatment and prevention of stroke. Cerebral angiography, which is an essential component of these procedures, has been used to provide morphological information regarding condition of blood vessels. In this study, we propose to determine the possibility of acquiring information regarding cerebral blood flow (CBF) in addition to morphologic information from data routinely available during angiography. METHODS: Digital subtraction angiography sequences were obtained for eight patients having occlusive disease in internal carotid artery (ICA) territories. Two regions-of-interest (ROIs) corresponding to the two brain hemispheres on AP view were delineated. For each image, the average pixel value within each ROI was calculated and used to generate time-density curves. Indices obtained from each curve were compared with each other and with the results obtained from the single photon emission computed tomography (SPECT) studies performed a pre- or postangiography procedure. RESULTS: Comparison between ICA stenosis and cerebral perfusion measurements revealed that cerebral perfusion deficit can be independent of arterial occlusive disease. The indices obtained from the time-density curves exhibit a correlating trend with the results from SPECT studies. However, lack of sufficient sample data prevented any meaningful statistical analysis to be conducted. CONCLUSIONS: We have developed a technique for utilizing the angiographic data for the important task of routinely and easily measuring CBF. Availability of CBF measurements during cerebral angiography may favorably impact upon the appropriate use of endovascular procedures and potentially contribute to the reduction of morbidity and mortality associated with stroke.

Aged↗

PubMed2006

Intra-arterial reteplase and intravenous abciximab in patients with acute ischemic stroke: an open-label, dose-ranging, phase I study.

OBJECTIVE: New approaches are focusing on using a combination of medication that lyse fibrin and prevent aggregation of platelets to achieve higher rates of recanalization and improved clinical outcomes. METHODS: A prospective, nonrandomized, open-label trial evaluated the safety of an escalating dose of reteplase in conjunction with intravenous abciximab (platelet glycoprotein IIb/IIIa inhibitor) in patients with acute ischemic stroke (3-6 h after symptom onset). The primary endpoint was symptomatic intracerebral hemorrhage at 24 to 72 hours, and secondary endpoints were partial or complete recanalization (> or = one grade improvement), early neurological improvement (decrease in National Institutes of Health Stroke Scale > or = 4 at 24 h), and favorable outcome at 1 month (defined by modified Rankin scale < or = 2). RESULTS: A total of 20 patients (mean age, 65 yr; 13 men) were recruited. Five patients were recruited in each of the escalating tiers of intra-arterial reteplase (0.5, 1, 1.5, and 2 units). Intravenous abciximab (0.25 mg/kg bolus followed by 0.125 mug/kg/min) was successfully administered in 18 out of 20 patients. The safety stopping rule was not activated in any of the tiers. One symptomatic intracerebral hemorrhage was observed in one of the 20 patients (in the 1-unit tier). Partial or complete recanalization was observed in 13 of the 20 patients. Thirteen patients demonstrated early neurological improvement, and favorable outcome at 1 month was observed in six patients. CONCLUSION: In this study, a combination of intra-arterial reteplase and intravenous abciximab was safely administered to patients with ischemic stroke presenting between 3 and 6 hours after symptom onset.

Abciximab↗

PubMed2006

Early and intermediate-term outcomes with drug-eluting stents in high-risk patients with symptomatic intracranial stenosis.

OBJECTIVE: To report the 1-month and intermediate-term results of treatment of symptomatic intracranial stenosis using drug-eluting stents. BACKGROUND: Patients with intracranial stenosis who are at high risk because of either high-grade stenosis or medication failure may have an annual risk of recurrent ischemic events in excess of 40%. Drug-eluting stents may reduce the rate of ischemic events in patients with a low restenosis rate. METHODS: We determined rates of technical success (defined as reduction of target lesion to stenosis <30%) and 1-month major stroke or death in patients with symptomatic intracranial stenosis (> or =70% and/or medication failure). Patients' clinical and follow-up information during a mean period of 14.3 +/- 7 months were obtained. Kaplan-Meier analysis was performed to determine the rate of major stroke-free survival during 12 months. RESULTS: There were 18 patients (mean age, 58 +/- 16 yr; 12 were men) treated with either a sirolimus-eluting stent (n = 14) or a paclitaxel-eluting stent (n = 4) for stenosis located in the: intracranial internal carotid artery (n = 6), proximal middle cerebral artery (n = 4), intracranial vertebral artery (n = 4), vertebrobasilar junction (n = 2), or basilar artery (n = 2). There was one major stroke and no death observed in the 1-month follow-up. At the 6-month follow-up examination, no major stroke or death was observed. Major stroke-free survival was 86% (+/-standard error of 9%) at 12 months after the procedure. One symptomatic angiographic restenosis was observed during the follow-up period. CONCLUSION: A low rate of major stroke or death was observed after treatment of symptomatic intracranial stenosis using drug-eluting stents in high-risk patients.

Blood Vessel Prosthesis↗

PubMed2005

Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000.

BACKGROUND: The Seventh Report of the Joint National Committee (JNC-7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provided a new classification of blood pressure for adults aged to guide screening and treatment efforts. MATERIAL/METHODS: Using the new classification, we examined trends and prevalence of pre-hypertension (120-139/80-89 mm Hg), stage 1 hypertension (140-159/90-99 mm Hg), and stage 2 hypertension (> or = 160/100 mm Hg) in a nationally representative sample of the United States population. We analyzed 4115 adult persons from 1999 and 2000 National Health and Nutrition Examination Survey (NHANES), 20,322 persons from NHANES II (1976-1980) and 30,818 persons from NHANES III (1988-1992). RESULTS: In the United States population aged 20 or greater, we found that an estimated 41.9 million men and 27.8 million women have pre-hypertension, 12.8 million men and 12.2 million women have stage 1 hypertension, and 4.1 million men and 6.9 million women have stage 2 hypertension. Age- and sex-adjusted rates of pre-hypertension increased among non-Hispanic White, African American, and Hispanic persons between 1988-1992 and 1999-2000. Age- and sex-adjusted rates of stage 1 hypertension increased among Hispanics between 1988-1992 and 1999-2000. Age- and sex-adjusted rates of stage 2 hypertension decreased among non-Hispanic Whites between 1988-1992 and 1999-2000, but were unchanged for African American and Hispanic persons. CONCLUSIONS: With over a 100 million persons with pre-hypertension or hypertension in the United States, a renewed effort directed towards screening, education, and treatment is required, particularly in the Hispanic population.

Adult↗

PubMed2005

Cigarette smoking among spouses: another risk factor for stroke in women.

BACKGROUND AND PURPOSE: It is well known that passive exposure to cigarette smoking increases the risk of coronary events, but the effect on the risk of stroke is not well defined. We performed this study to determine the effect of cigarette smoking among spouses on the risk of developing stroke and ischemic stroke among a nationally representative sample of women. METHODS: We examined the association between history of smoking among spouses with the incidence of stroke in a national cohort of 5379 women who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study. RESULTS: During a mean follow-up of 8.5 years, the risk was significantly increased for all strokes (relative risk, 5.7; 95% CI, 1.4 to 24) and ischemic stroke (relative risk, 4.8; 95% CI, 1.2 to 20) among cigarette-smoking women with a cigarette-smoking spouse compared with those with a nonsmoking spouse after adjusting for other cardiovascular risk factors. CONCLUSIONS: The study provides new evidence linking spousal smoking to stroke.

Adult↗

PubMed2005

Is prehypertension a risk factor for cardiovascular diseases?

BACKGROUND AND PURPOSE: The Joint National Committee on High Blood Pressure identified a new category of blood pressure in adults termed prehypertension. Our objective was to determine the long-term risk of cardiovascular diseases associated with this new category in a well-defined cohort of adults. METHODS: We evaluated the association of prehypertension (120 to 139/80 to 89 mm Hg) and hypertension (>140/90 mm Hg) with the incidence of atherothrombotic brain infarction (ABI), all strokes, myocardial infarction (MI), and coronary artery disease (CAD) using pooled repeated measures and Cox proportional hazards analyses during follow-up after adjusting for age, gender, obesity, diabetes mellitus, hypercholesterolemia, cigarette smoking, and study period in a cohort of 5181 persons who participated in the Framingham Study. RESULTS: Among the 11,116 person observations with a mean follow-up period of 9.9+/-1.0 years, prehypertension was not associated with an increased risk for ABI (relative risk [RR], 2.2; 95% CI, 0.5 to 9.3). Among the 11,802 person observations with a mean follow-up period of 9.7+/-1.5 years, prehypertension was associated with an increased risk for MI (RR, 3.5; 95% CI, 1.6 to 7.5). Prehypertension was also associated with an increased risk of CADs among the 11,570 person observations (RR, 1.7; 95% CI, 1.2 to 2.4). CONCLUSIONS: Prehypertension appears to be associated with an increased risk of MI and CAD but not stroke. Further studies are required to confirm the anticipated benefits of identifying and intervening in persons with prehypertension.

Adult↗

PubMed2005

Intracranial hemorrhages associated with intravenous platelet glycoprotein IIB/IIIA receptor inhibitors in the United States.

OBJECTIVES: To determine the rates of intracranial hemorrhages associated with GP IIb/IIIa inhibitors in routine practice. BACKGROUND: Rates of intracranial hemorrhages (ICH) among patients treated with platelet glycoprotein (GP) IIb/IIIa inhibitors for coronary interventions and acute coronary syndromes have been studied within clinical trials but not in routine practice. METHODS: We evaluated the rates of ICH in routine practice in United States (US) using national estimates of rates, in-hospital outcomes, and mortality obtained from National Hospital Discharge Survey. RESULTS: There were 367 294 patients aged 18 years or greater who were treated with platelet GP IIb/IIIa inhibitors between 2000 and 2002 in United States. ICH was observed in 479 (0.13%) of the 367,294 patients with a 100% associated mortality. ICHs related to GP IIb/IIIa inhibitors comprised 0.12% of the total number of ICHs (n = 411 621) observed in United States between 2000 and 2002. CONCLUSIONS: ICH related to platelet GPIIb/IIIa inhibitors is uncommon but associated with high mortality.

Adolescent↗

PubMed2005

What proportion of stroke is not explained by classic risk factors?

Ischemic stroke is a complex entity with multiple etiologies and variable clinical manifestations. The most frequent cause of stroke is atherosclerosis of cerebral vasculature followed by cardioembolism. Two thirds of strokes are explained by identifiable risk factors. Age, hypertension, and nonvalvular atrial fibrillation are by far the most frequent and well documented ones. Approximately 5% of strokes are caused by conditions other than atherosclerosis or heart disease, i.e., cervical arteries dissections, nonatherosclerotic vasculopathies, infectious or systemic vasculitis, and collagen vascular diseases. In spite of a thorough diagnostic evaluation, 30% of strokes remain cryptogenic, i.e., no specific cause is identified and the classic risk factors are not present. Identification of unknown environmental or genetic risk factors should be the subject of further research.

Age Distribution↗

PubMed2005

Advances in thrombolytics and mechanical devices for treatment of acute ischemic stroke.

Stroke is a leading cause of death and disability. Recently, there have been advances in the treatment of acute ischemic stroke aimed at re-establishing blood flow to the affected area in an effort to save the ischemic penumbra surrounding the area of infarction. This is achieved by the use of thrombolytics intravenously or intra-arterially. The use of mechanical devices facilitates the function of pharmacological agents used in addition to minimizing the associated risks. In this review, we first discuss the therapeutic potentials and strategies employed in using different thrombolytics in management of acute ischemic stroke. Subsequently, we discuss the recent advances and therapeutic applications of mechanical devices in this field.

Brain Ischemia↗

PubMed2005

Endovascular treatment of subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) is a common and devastating form of stroke. A large number of patients with aSAH develop angiographic or clinical vasospasm responsible for high morbidity and mortality. Rapid advances in the field of interventional neurology and the development of minimally invasive techniques have resulted in expansion of potential therapeutic applications. Treatment of aSAH has benefited from this rapid advance in the field of endovascular therapies. In the first section of the review, we discuss the therapeutic options and techniques for embolizations of intracranial aneurysms. In the second section, we discuss evolving endovascular treatment methods employed to intervene in delayed complications of cerebral vasospasm in patients with aSAH.

Angioplasty, Balloon↗

PubMed2005

Carotid angioplasty with or without stent placement versus carotid endarterectomy for treatment of carotid stenosis: a meta-analysis.

OBJECTIVE: Carotid angioplasty with or without stent placement (CAS) has been proposed as an alternative method to carotid endarterectomy (CEA) for treatment of carotid stenosis. Small randomized trials have evaluated the comparative efficacy of both methods; however, definitive evidence is lacking. METHODS: A search was made for randomized clinical trials comparing CAS and CEA for treatment of carotid stenosis. A literature search of MEDLINE, PubMed, and Cochrane databases was supplemented by a review of bibliographies of relevant articles and personal files. A meta-analysis was performed using a random effects model because significant heterogeneity was observed. Outcomes compared included 1-month composite rates of stroke or death, all strokes, disabling strokes, myocardial infarction, cranial nerve injury, and major bleeding and 1-year rates of both minor and major ipsilateral strokes. RESULTS: We analyzed five randomized trials totaling 1154 patients (577 randomized to CEA and 577 randomized to CAS). The composite end point of 1-month stroke or death rate was not different between patients treated with CAS compared with those treated with CEA (relative risk [RR], 1.3; 95% confidence interval [CI], 0.6-2.8; P = 0.5). The 1-month stroke rate (831 patients analyzed: RR, 1.3; 95% CI, 0.4-3.6; P = 0.7) and disabling stroke rate (831 patients analyzed: RR, 0.9; 95% CI, 0.2-3.5; P = 0.9) was similar for CAS and CEA. The 1-month rates of myocardial infarction (814 patients analyzed: RR, 0.3; 95% CI, 0.1-0.9) and cranial nerve injury (918 patients analyzed: RR, 0.05; 95% CI, 0.01-0.3) were significantly lower for CAS. No significant differences were observed in 1-year rates of ipsilateral stroke (814 patients analyzed: RR, 0.8; 95% CI, 0.5-1.2; P = 0.2). CONCLUSION: The 30-day stroke and death rates associated with CAS and CEA were not significantly different. Lower rates of myocardial infarction and cranial nerve injury were observed with CAS compared with CEA.

Angioplasty↗

PubMed2005

Trends in hospitalization and mortality for subarachnoid hemorrhage and unruptured aneurysms in the United States.

OBJECTIVE: During the past decade, endovascular obliteration of intracranial aneurysms and new treatments for vasospasm and cerebral ischemia have been introduced. To analyze the effectiveness of these new strategies, we evaluated changes in morbidity and mortality rates in patients at least 18 years of age who were hospitalized for ruptured and unruptured intracranial aneurysms during the past 16 years. METHODS: National estimates of hospitalization for subarachnoid hemorrhage (SAH) and unruptured intracranial aneurysms and associated in-hospital outcomes and mortality were obtained from National Hospital Discharge Survey data. All the variables pertaining to hospitalization were compared for three distinct time periods: 1986-1990, 1991-1995, and 1996-2001. RESULTS: There were 94,692, 104,746, and 133,269 admissions for SAH during the periods 1986-1990, 1991-1995, and 1996-2001, respectively. Mortality rates for hospitalizations related to SAH demonstrated no significant change in mortality during the periods 1986-1990, 1991-1995, and 1996-2001 (27.6%, 24.6%, and 26.3%, respectively. Procedures performed for SAH from 1996 to 2001 included surgical clipping (28%), endovascular/wrapping (2%), and no procedure (70%). The number of admissions for unruptured intracranial aneurysms was 23,481 from 1986 to 1990, 28,017 from 1991 to 1995, and 51,904 from 1996 to 2001. There was an overall trend (P = 0.07) toward reduced in-hospital mortality during the three periods: 5.9%, 6.3%, and 1.4% for 1986-1990, 1991-1995, and 1996-2001, respectively. CONCLUSION: The mortality rate for unruptured intracranial aneurysms demonstrates a significant trend of reduction during the past 16 years. The mortality rate for SAH demonstrates limited change during the same period; it is presumed that this is attributable to the multitude of factors that influence outcome.

Adolescent↗