A 60-year-old woman with a subarachnoid hemorrhage (SAH) from a ruptured anterior communicating artery aneurysm has a Hunt and Hess grade III. When is the optimal timing for aneurysm clipping or coiling?
- A Day 7–14 (during cerebral vasospasm peak)
- B After day 14 when vasospasm resolves
- C Within 24–72 hours (early intervention) ✓
- D Conservative management; surgery only if rebleed occurs
Correct answer: C. Within 24–72 hours (early intervention)
Explanation
Current guidelines recommend early intervention (within 24–72 hours) for ruptured intracranial aneurysms, as rebleeding risk is highest in the first 24 hours (15–20% risk within 24 hours) and carries a 60–70% mortality. Endovascular coiling (ISAT trial) or microsurgical clipping can be performed. Days 7–14 represent peak vasospasm risk when intervention is most hazardous. Hunt and Hess grade III (moderate headache, mild neurological deficits) is not a contraindication to early intervention; grades IV–V may have intervention deferred depending on clinical state.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.