Complications and clinical outcomes according to treatment modality for aneurysmal subarachnoid hemorrhage: a retrospective cohort in an intensive care unit in Paraguay

Abstract

Introduction. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurocritical emergency associated with high morbidity and mortality. Definitive treatment includes microsurgical clipping (MC) and endovascular therapy (EVT). Objective. To compare clinical characteristics, complications, and in-hospital outcomes of patients with aSAH treated with MC or EVT in an intensive care unit in Paraguay. Materials and Method. This retrospective cohort included 196 adults with aSAH admitted between January 2023 and July 2025; 147 underwent MC and 49 received EVT. Demographic characteristics, baseline severity, neurological and systemic complications, mortality, ICU length of stay, and duration of mechanical ventilation were analyzed. Results. Relevant baseline differences were observed between groups; patients treated with EVT were younger and had lower neurological severity on some scales. Symptomatic vasospasm was less frequent with EVT than with MC (8.2% vs. 25.2%; p=0.013), as were hydrocephalus (2.0% vs. 15.0%; p=0.018) and in-hospital mortality (4.1% vs. 25.2%; p=0.007). The EVT group also had shorter ICU stays and fewer days of mechanical ventilation. No significant differences were observed in rebleeding, delayed cerebral ischemia, cardiovascular events, or infections. Conclusion. Patients treated with EVT had lower mortality, symptomatic vasospasm, hydrocephalus, and ICU resource utilization. However, baseline differences and clinical treatment selection limit causal attribution of these findings. Analyses adjusted for baseline severity and other prognostic factors are needed.