Complications and Clinical Outcomes of Aneurysmal Subarachnoid Hemorrhage following Endovascular Intervention: A Retrospective Tertiary ICU-Based Study from Nepal

Abstract

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurological emergency associated with a significant global burden of morbidity and mortality. Although advances in endovascular intervention have improved survival and neurological outcomes, post-procedural complications continue to pose significant challenges, particularly in intensive care settings. Evidence regarding the clinical profile, complications, and outcomes of patients with aSAH undergoing endovascular treatment in Nepal remains limited. This study aimed to evaluate the demographic characteristics, aneurysm profile, post-procedural complications, and clinical outcomes of patients with aSAH managed with endovascular intervention in a tertiary care intensive care unit in Nepal.

Methods: This study was conducted in the Intensive Care Unit of Grande International Hospital, Kathmandu, Nepal. Patients with aSAH who underwent endovascular intervention between February 2023 and February 2026 were included. Demographic characteristics, aneurysm location, complications, and outcomes were analyzed. Categorical variables were expressed as frequency and percentage, while quantitative variables were expressed as mean ± standard deviation or median with interquartile range.

Results: A total of 50 patients were included. The mean age was 55.9 ± 10.8 years, with female predominance (56%). The anterior communicating artery was the most common aneurysm location (30%). The most frequent complications were infection (24%), vasospasm (22%), procedure-related intracranial hematoma (18%), EVD placement (12%), and hyponatremia (12%). The median ICU stay was 5.5 days, and mortality occurred in 4% of patients.

Conclusion: Endovascular management of aSAH showed favorable overall outcomes with low mortality; however, complications such as infection and vasospasm remained common. These findings provide important local data that may help optimize neurocritical care practices for aSAH in Nepal