Impact of intervention timing on clinical outcomes in patients with ruptured intracranial aneurysms: Analysis of treatment delays and neurological prognosis

To evaluate the impact of intervention timing on clinical outcomes in patients with ruptured intracranial aneurysms (RIAs) and analyze the relationship between treatment delay and neurological prognosis. We retrospectively analyzed clinical data of 198 patients with RIAs who underwent endovascular intervention in our neurosurgery department from January 2021 to March 2024. Patients were divided into early intervention group (≤72 hours, n=116) and delayed intervention group (>72 hours, n=82) based on the time interval from bleeding to endovascular treatment. Demographic characteristics, clinical presentations, Hunt-Hess grades, Fisher grades, aneurysm characteristics, surgical details, complications, length of hospital stay, and follow-up data were collected. The primary outcome measure was the modified Rankin Scale (mRS) score at discharge and 6-month follow-up, while secondary outcomes included angiographic results, rebleeding rate, vasospasm incidence, and mortality. Multivariate logistic regression analysis showed that, after adjusting for confounding factors such as age, Hunt-Hess grade, Fisher grade, aneurysm size, and location, patients in the early intervention group had significantly higher odds of achieving favorable clinical outcomes (mRS≤2) compared to the delayed intervention group (OR=0.56, 95%CI: 0.37-0.85, P=0.007). The early intervention group had significantly lower rebleeding rates than the delayed intervention group (3.4% vs. 8.5%, P=0.018) and shorter hospital stays (15.2±5.8 days vs. 20.7±6.9 days, P<0.001). Vasospasm incidence was higher in the delayed intervention group (30.5% vs. 19.8%, P=0.012). Multivariate analysis identified Hunt-Hess grade ≥4 (OR=3.42, 95%CI: 2.05-5.71, P<0.001), intervention delay >72 hours (OR=1.78, 95%CI: 1.16-2.73, P=0.008), and age >65 years (OR=1.69, 95%CI: 1.10-2.58, P=0.016) as independent risk factors for poor neurological outcomes. Our findings suggest that early (≤72 hours) endovascular intervention for patients with ruptured intracranial aneurysms is associated with better neurological outcomes.