Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
LetterLetter

Reply:

S.K. Natarajan and L.N. Sekhar
American Journal of Neuroradiology November 2008, 29 (10) e99; DOI: https://doi.org/10.3174/ajnr.A1199
S.K. Natarajan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
L.N. Sekhar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

We thank Bansal and Derdeyn for their critical review of our manuscript.

First, they have pointed out that the improvement of outcomes in our series,1 when compared with 2 previous reports in 1995 and 1996,2,3 were limited to patients with Hunt and Hess (HH) scale grades IV and V and are at the expense of worse outcomes in patients admitted with HH scale grades I-III. Le Roux et al2,3 reported favorable outcomes (Glasgow Outcome Scores [GOS] 4 and 5) at 6 months after subarachnoid hemorrhage (SAH) in their series of patients treated from 1983 to 1993. GOS 4 and 5 includes patients who have good recovery and patients with moderate disability.4 In our series,1 favorable outcomes (modified Rankin Scale [mRS] scores, 0–2) were measured at 3 months after SAH. mRS 0–2 includes patients who have good recovery and patients who have slight disability.5 Patients with moderate disability (mRS 3) were not considered to have favorable outcomes in our series. The Table gives a comparison between the series from Le Roux et al2,3 and our series after including patients who had moderate disability (mRS 3) at 3 months as patients with favorable outcome.

The outcomes after including mRS 3 as favorable outcomes in our series are comparable with the outcomes of Le Roux et al2,3 in good-grade patients, despite the difference in the timeline at which outcomes were measured in these 2 series. We agree that the improvement in overall outcomes is mainly due to improvement in outcomes of patients with grades IV and V, but this is not at the expense of worse outcome in good-grade patients. It is not possible to compare our results statistically with previously reported series due to variability in instruments used for outcome measures and the time after SAH at which outcomes were measured.

Second, Bansal and Derdeyn have pointed out that our study1 was not designed in a fashion that would allow meaningful comparison of outcomes of patients after clipping or coiling. We agree with them and have acknowledged in the article that this study has limitations because it is retrospective and the pretreatment variables were matched retrospectively by logistic regression analysis. The technique of treatment (clipping or coiling) was not a predictor of the 3-month outcomes after SAH in this group of patients. The main predictor of outcomes was the severity of the hemorrhage (HH scale grade, intracerebral hemorrhage). There were differences between the patients who had clipped and coiled aneurysms in their pretreatment variables (worse hemorrhage grades and more comorbidities in the patients with coiled aneurysms), aneurysm variables (more wide-necked aneurysms in the patients with clipped aneurysms), rebleed rates (1 after clipping and none after coiling), posttreatment secondary insults (more vasospasm in the patients with clipped aneurysms), and discharge destinations (more patients with clipped aneurysms went to rehabilitation, and more patients with coiled aneurysms went home). Logistic regression retrospectively matched the differences in the pretreatment variables (including HH scale grade) between the 2 groups, and there were no significant differences in the 3-month mRS scores between the patients with clipped and coiled aneurysms. This re-emphasizes the fact that in our study, selection of treatment technique did not determine the 3-month mRS score after SAH.

Further outcome studies are being conducted in our institution that analyze patients with grade I and II, grade III and IV, and grade V separately. These studies may allow a more meaningful comparison between these groups. The object of our study was not to show the superiority of 1 technique over another. Because the patients are generally selected for treatment primarily on the basis of aneurysm morphology (dome-to-neck ratio), age, and HH scale grade, parity of outcomes between the 2 groups will confirm the validity of the selection process. If 1 group of patients has distinctly better outcomes than another when the groups are stratified according to the HH scale grade, then our selection process has to be re-evaluated.

View this table:
  • View inline
  • View popup

Comparison between the series from Le Roux et al and our series after including patients who had moderate disability

References

  1. ↵
    Natarajan SK, Sekhar LN, Ghodke B, et al. Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center. AJNR Am J Neuroradiol 2008;29:753–59
    Abstract/FREE Full Text
  2. ↵
    Le Roux PD, Elliott JP, Newell DW, et al. Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 1996;85:39–49
    PubMed
  3. ↵
    Le Roux PD, Elliott JP, Downey L, et al. Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg 1995;83:394–402
    PubMed
  4. ↵
    Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480–84
    PubMed
  5. ↵
    Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke 1988;19:1497–500
    Abstract/FREE Full Text
  • Copyright © American Society of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 29 (10)
American Journal of Neuroradiology
Vol. 29, Issue 10
November 2008
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Reply:
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Reply:
S.K. Natarajan, L.N. Sekhar
American Journal of Neuroradiology Nov 2008, 29 (10) e99; DOI: 10.3174/ajnr.A1199

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Reply:
S.K. Natarajan, L.N. Sekhar
American Journal of Neuroradiology Nov 2008, 29 (10) e99; DOI: 10.3174/ajnr.A1199
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Fair Performance of CT in Diagnosing Unilateral Vocal Fold Paralysis
  • Reply:
  • Regarding “Altered Blood Flow in the Ophthalmic and Internal Carotid Arteries in Patients with Age-Related Macular Degeneration Measured Using Noncontrast MR Angiography at 7T”
Show more LETTERS

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire