ArticleFrontiers in radiology2026
Access to care, treatment pathways, and outcomes of endovascular treatment for aneurysmal subarachnoid hemorrhage in Kazakhstan: a retrospective cohort study.
Article in Frontiers in radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Aneurysmal subarachnoid hemorrhage (aSAH) remains a major cause of mortality and disability worldwide. Outcomes after aSAH are influenced not only by hemorrhage severity and aneurysm characteristics but also by patient comorbidities, healthcare organization, and access to specialized neurovascular care. This study evaluated clinical and health-system determinants of functional outcome after aSAH in Kazakhstan. Methods: We conducted a single-center retrospective cohort study of 483 patients with ruptured intracranial aneurysms treated endovascularly at a national tertiary neurovascular center (2016-2024). Early aneurysm occlusion was defined as treatment within 24 h of symptom onset. For cohort analyses, patients treated within 14 days were classified as the acute group, whereas those treated after 14 days comprised the delayed-treatment group, including both referral-related delays and deferred treatment after clinical stabilization. Demographic, clinical, radiological, and procedural variables were analyzed. Functional outcomes were assessed using the modified Rankin Scale (mRS) at discharge, 6 months, and 12 months. Favorable recovery was defined as mRS ≤2 at 6-12 months. Results: The mean age was 52.6 years, and 65.4% were female. Rural residence was associated with delayed access to treatment (60.9% vs. 42.9%, Conclusions: Functional outcome after aneurysmal SAH within a centralized upper-middle-income neurovascular system was driven primarily by neurological status, systemic comorbidity, and procedural safety rather than aneurysm anatomy. Given the treatment-based referral design and survivorship bias inherent in tertiary transfer cohorts, these findings suggest that centralized systems facilitate access to specialized neurovascular care for patients reaching tertiary centers. Strengthening complication prevention, cardiovascular risk reduction, and referral pathways may improve neurovascular outcomes.
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