🔔 Clinical Outcomes: Unfavorable Clinical Outcomes: Before PSM, unfavorable clinical outcomes (mRS scores 3-6) were 72.0% for SC and 66.2% for EC (P = .026). After PSM, these were 70.6% for SC and 63.3% for EC (P = .025). In-Hospital Mortality: Before PSM, in-hospital mortality was significantly higher for EC (16.1%) compared to SC (10.5%, P = .003). After PSM, the difference was not significant (EC: 12.7%, SC: 10.4%, P = .384). 🎤 Predictors of Unfavorable Outcomes: 🥁 Common Predictors: WFNS grade V, age older than 70 years, and Fisher CT grade 4 were predictors of unfavorable outcomes in both SC and EC groups. 🥁 SC-Specific Predictors: WFNS grade IV and Fisher CT grade 3 were associated with unfavorable outcomes only in the SC group. 🥁 EC-Specific Predictors: Ages in the 50s and 60s were associated with unfavorable outcomes only in the EC group. 🎤 Conclusion: EC was associated with significantly more favorable clinical outcomes than SC in patients with poor-grade aSAH, without significant differences in in-hospital mortality after PSM. The benefit of EC over SC might be particularly notable in patients with WFNS grade IV and Fisher CT grade 3. 📣 📣 Implications on Clinical Practice ✅ Treatment Strategy Shift: The findings suggest that EC may be preferred over SC for patients with poor-grade aSAH due to better clinical outcomes at discharge. This could lead to a shift in treatment protocols favoring EC, especially in high-risk cases. ✅ Patient Selection: Clinicians might consider WFNS grade IV and Fisher CT grade 3 as indicators for opting for EC over SC. Understanding the specific predictors of unfavorable outcomes can help tailor treatment plans to individual patient profiles, potentially improving overall outcomes. ✅ Age Considerations: With older age being a significant predictor of unfavorable outcomes, more careful consideration and possibly more aggressive management might be necessary for elderly patients undergoing either EC or SC. ✅ Resource Allocation: High-volume cerebrovascular centers equipped to perform both SC and EC may need to allocate more resources and training towards enhancing EC capabilities, given its demonstrated advantages. ✅ Guideline Revisions: The study’s results might influence revisions of existing guidelines from bodies such as the American Heart Association/American Stroke Association and European Stroke Organization to reflect the potential superiority of EC in poor-grade aSAH cases.
