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22. European Stroke Conference 9 Intracerebral/subarachnoid haemorrhage and venous diseases 11:50 - 12:00 Very long-term outcome after aneurysmal subarachnoid haemorrhage – risk of new vas-cular events and death. A. de Wilde1, D.J. Nieuwkamp2, M.J.H. Wermer3, A. Algra4, G.J.E. Rinkel5 UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, THE NETHERLANDS1,UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, THE NETHERLANDS2, Department of Neurology, Leiden University Medical Center, Leiden, THE NETHERLANDS3, UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery and Julius Center, University Medical Center Utrecht., Utrecht, THE NETHERLANDS4, UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, the Rudolf Magnus Insti-tute of Neuroscience, University Medical Center Utrecht, Utrecht, THE NETHERLANDS5 Background Few prospective data are available on very long-term risks of vascular events and cancer relat-ed and overall death after subarachnoid haemorrhage (SAH). Therefore, we assessed these risks in a large prospective cohort of SAH patients. Methods We determined vascular events and survival status in 1,765 patients with aneurysmal SAH ad-mitted to our center from 1985 to 2010. Cumulative risks were estimated with survival analysis. We compared the risk of vascular, cancer related and all-cause death with the general popula-tion with standardized mortality ratios (SMRs). Furthermore, we compared incidences of vas-cular events and death with those in age and sex adjusted patients with a TIA or minor stroke. Results Conditional on survival of 3 months after the SAH, the risk of death was 8.7% (95%CI:7.3- 10.1%) within 5 years, 17.9% (16.1-19.9%) within 10 years, 29.5% (27.3-31.8%) within 15 years and 43.6% (41.2-46.1%) within 20 years after SAH. Compared with the general popula-tion, the SMR for vascular death was 2.0 (95%CI:1.6-2.5), for cancer related death 1.2 (0.9-1.5) and for all-cause death 1.8 (1.6-2.1). The increased SMR for all-cause death was stable up to 20 years after SAH. Compared with patients with TIA/minor stroke, the cumulative incidence on vascular events was lower for patients with SAH (hazard ratio HR 0.48; 95%CI:0.40-0.57); the HR for all-cause death was 0.96 (95%CI:0.84-1.10). Conclusions Risks of vascular events and death after aneurysmal SAH are increased. The increased risk of death perseveres up to 20 years after SAH. The data also suggest an increased risk of death from cancer. Although the long-term risk of vascular events was lower in patients after SAH compared with patients after TIA or minor stroke, the long-term risk of death did not differ. 8 Intracerebral/subarachnoid haemorrhage and venous diseases 11:40 - 11:50 Subarachnoid hemorrhage with aneurysmal pattern and negative angiography: evalua-tion of long-term rebleeding R. Geraldes1, A.C. Castro-Caldas2, D. Sousa3, P. Canhão4, T.P. Melo5 Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTU-GAL1, Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL2, Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL3, Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL4, Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL5 Background: Long-term follow-up studies of patients with spontaneous nonaneurysmal sub-arachnoid haemorrhage (SAH) suggest that the risk of rebleeding depends on the pattern of blood distribution at the initial Brain CT, ranging from 0-11% in SAH with aneurysmal pattern and negative angiography (SAH-APNA). We aimed to evaluate the occurrence of rebleeding in the long-term follow up in patients with SAH-APNA. Methods: We retrieved all cases with spontaneous SAH with aneurysmal pattern, with diffuse distribution of hematic densities on Brain CT (perimesencephalic and exclusively convexal SAHs were excluded) and at least two normal digital subtraction angiographies (DSA), consecutively admitted to the Stroke Unit (January 2005-December 2011). We collected data from the Stroke Unit database, discharge notes, outpatient files, and a follow-up interview to identify rebleeding, re-admissions, dis-ability (modified Rankin scale, mR), death and causes of death. Results: Of 255 patients with SAH admitted during the study period 54 patients were included, mean age of 55.8 ± 12 years, 26 women, 79.6% scoring <3 at the Hunt&Hess scale. Follow-up was obtained in 52 patients (96.3%), with mean follow-up time of 50.7 ± 23.0 months. The majority of patients were inde-pendent (88.5%), 3 (5.6%) remained dependent (mR3) and 2 died (1 cancer, 1 sepsis). A patient with Paramyloidosis had a recurrent SAH two years after the SAH. Repeated DSA was normal. This patient suddenly died 4 months after the rebleeding but no autopsy was performed. An-other patient was readmitted with sudden headache, three years after the SAH, being diagnosed with cerebral hemosiderosis secondary to pseudomeningocele. Conclusion: We confirmed a low rate of rebleeding in SAH-APNA and we did not find vascular malformations in repeated DSA in such cases, reinforcing that our strategy of performing two cerebral DSA in evaluating SAH-APNA might be appropriate. However, longer follow-up of these patients is warranted. 132 © 2013 S. Karger AG, Basel Scientific Programme


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