Aneurysmal Subarachnoid Hemorrhage in a Mexican Multicenter Registry of Cerebrovascular Disease: The RENAMEVASC Study

Ruiz-Sandoval, José L.; Cantú, Carlos; Chiquete, Erwin; León-Jiménez, Carolina; Arauz, Antonio; Murillo-Bonilla, Luis M.; Villarreal-Careaga, Jorge; Barinagarrementería, Fernando; The RENAMEVASC Investigators,

doi:10.1016/j.jstrokecerebrovasdis.2008.09.019

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 1 , Pages 48-55, January 2009

Aneurysmal Subarachnoid Hemorrhage in a Mexican Multicenter Registry of Cerebrovascular Disease: The RENAMEVASC Study

José L. Ruiz-Sandoval, MD
- Department of Neurology and Neurosurgery, Hospital Civil de Guadalajara “Fray Antonio Alcalde”
- Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
- Address correspondence to José L. Ruiz-Sandoval, MD, Servicio de Neurología y Neurocirugía, Hospital Civil de Guadalajara “Fray Antonio Alcalde,” Hospital 278, Guadalajara, Jalisco, Mexico 44280.
Carlos Cantú, MD, PhD
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” Mexico City
Erwin Chiquete, MD, PhD
- Department of Neurology and Neurosurgery, Hospital Civil de Guadalajara “Fray Antonio Alcalde”
- Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara
Carolina León-Jiménez, MD
- Department of Neurology, Hospital Regional Gómez Farías, Zapopan
Antonio Arauz, MD, PhD
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City
Luis M. Murillo-Bonilla, MD, MSc
- Department of Neurology, Instituto Panvascular de Occidente, Guadalajara
Jorge Villarreal-Careaga, MD
- Department of Neurology, Hospital General de Culiacán
Fernando Barinagarrementería, MD
- Department of Neurology, Hospital Ángeles Querétaro, México
The RENAMEVASC Investigators

Received 22 May 2008; received in revised form 1 September 2008; accepted 11 September 2008.

Background

Information on risk factors and outcome of persons with aneurysmal subarachnoid hemorrhage (SAH) in Mexico is unknown. We sought to describe the clinical characteristics, risk factors, and outcome at discharge of Mexican patients with aneurysmal SAH.

Methods

A first-step surveillance system was conducted on consecutive cases confirmed by 4-vessel angiography from November 2002 to October 2004 in 25 tertiary referral centers. Age- and sex-matched control subjects were randomly selected by a 1:1 factor, for multivariate analysis on risk factors.

Results

We studied 231 patients (66% women; mean age 52 years, range 16-90 years). In 92%, the aneurysms were in the anterior circulation, and 15% had more than two aneurysms. After multivariate analysis, hypertension (odds ratio 2.46, 95% confidence interval 1.59-3.81) and diabetes mellitus (odds ratio 0.34, 95% confidence interval 0.17-0.68) were directly and inversely associated with aneurysmal SAH, respectively. Median hospital stay was 23 days (range 2-98 days). Invasive treatment was performed in 159 (69%) patients: aneurysm clipping in 126 (79%), endovascular coiling in 29 (18%), and aneurysm wrapping in 4 (2%). The in-hospital mortality was 20% (mostly due to neurologic causes), and 25% of patients were discharged with a modified Rankin score of 4 or 5.

Conclusions

Hypertension is the main risk factor for aneurysmal SAH in hospitalized patients from Mexico. The female:male ratio is 2:1. A relatively low in-hospital mortality and a high frequency of invasive interventions are observed. However, a high proportion of patients are discharged with important neurologic impairment.

Key Words: Cerebral aneurysm, epidemiology, outcome, risk factors, subarachnoid hemorrhage