{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T06:45:51Z","timestamp":1782456351517,"version":"3.54.5"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Radiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective cohort study of 483 patients with ruptured intracranial aneurysms treated endovascularly at a national tertiary neurovascular center (2016\u20132024). Early aneurysm occlusion was defined as treatment within 24\u2005h 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 \u22642 at 6\u201312 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In the representative 2021 referral cohort, the median interval from SAH onset to arrival at the tertiary neurovascular center was 26 days (IQR 9\u201354), reflecting substantial referral and transfer delays within the centralized healthcare system. In multivariable analysis, periprocedural complications (adjusted OR 8.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and ischemic heart disease (adjusted OR 3.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) were independently associated with mRS 3\u20136, whereas higher admission Glasgow Coma Scale scores were protective (adjusted OR 0.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Aneurysm morphology and traditional SAH severity scales were not independently associated with long-term outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fradi.2026.1845453","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:46:49Z","timestamp":1782452809000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Access to care, treatment pathways, and outcomes of endovascular treatment for aneurysmal subarachnoid hemorrhage in Kazakhstan: a retrospective cohort study"],"prefix":"10.3389","volume":"6","author":[{"given":"Mynzhylky","family":"Berdikhojayev","sequence":"first","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiman","family":"Maidan","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology and Neurosurgery, Instituto M\u00e9dico ENERI, Cl\u00ednica La Sagrada Familia","place":["Buenos Aires, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlygash","family":"Toguzbaeva","sequence":"additional","affiliation":[{"name":"Asfendiyarov Kazakh National Medical University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimash","family":"Davletov","sequence":"additional","affiliation":[{"name":"Asfendiyarov Kazakh National Medical University","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abzal","family":"Zhumabekov","sequence":"additional","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayakhmet","family":"Makhanbetkhan","sequence":"additional","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daulet","family":"Suieumbetov","sequence":"additional","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rauan","family":"Aiteli","sequence":"additional","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxat","family":"Mussabekov","sequence":"additional","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger Barranco","family":"Pons","sequence":"additional","affiliation":[{"name":"Al Qassimi Hospital","place":["Sharjah, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marat","family":"Sarshayev","sequence":"additional","affiliation":[{"name":"National Hospital of the Medical Center of the Presidential Affairs Administration of the Republic of Kazakhstan","place":["Almaty, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"B1","article-title":"Subarachnoid hemorrhage","volume-title":"StatPearls","author":"Ziu","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1186\/s13054-015-1036-0","article-title":"Subarachnoid hemorrhage: who dies, and why?","volume":"19","author":"Lantigua","year":"2015","journal-title":"Crit Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s41016-025-00419-1","article-title":"Addressing global disparities in neurosurgical workforce and access to care","volume":"11","author":"Alokozay","year":"2025","journal-title":"Chin Neurosurg J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"607","DOI":"10.5137\/1019-5149.JTN.43486-23.5","article-title":"Predictors of outcome in aneurysmal subarachnoid hemorrhage: a tertiary center experience","volume":"34","author":"Ergenc","year":"2024","journal-title":"Turk Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"506","DOI":"10.25259\/SNI_576_2021","article-title":"Definitions of intracranial aneurysm size and morphology: a call for standardization","volume":"12","author":"Merritt","year":"2021","journal-title":"Surg Neurol Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0323453","DOI":"10.1371\/journal.pone.0323453","article-title":"Systematic analysis of the global, regional, and national burden of subarachnoid hemorrhage from 1990 to 2021","volume":"20","author":"Li","year":"2025","journal-title":"PLoS One"},{"key":"B7","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1186\/s12883-022-02892-y","article-title":"Risk factors for aneurysm rupture among Kazakhs: findings from a national tertiary hospital","volume":"22","author":"Medetov","year":"2022","journal-title":"BMC Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2336","DOI":"10.3390\/jcm14072336","article-title":"Improving acute ischemic stroke care in Kazakhstan: cross-sectional survey","volume":"14","author":"Makhanbetkhan","year":"2025","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"S13","DOI":"10.4103\/0976-3147.196459","article-title":"Successful endovascular neurosurgical practice in resource-poor exclusive rural neuro-hospital setup","volume":"7","author":"Harsha","year":"2016","journal-title":"J Neurosci Rural Pract"},{"key":"B10","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.11.018","article-title":"Cerebral aneurysm classification based on angioarchitecture","volume":"20","author":"Pritz","year":"2011","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B11","article-title":"Cerebral aneurysm","volume-title":"StatPearls","author":"Jersey","year":"2025"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e314","DOI":"10.1161\/STR.0000000000000436","article-title":"2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American stroke association","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"B13","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1093\/abm\/kaad015","article-title":"The perceived stress scale as a measure of stress: decomposing score variance in longitudinal behavioral medicine studies","volume":"57","author":"Harris","year":"2023","journal-title":"Ann Behav Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3389\/fneur.2018.00380","article-title":"Number of cigarettes smoked per day, smoking Index, and intracranial aneurysm rupture: a case\u2013control study","volume":"9","author":"Feng","year":"2018","journal-title":"Front Neurol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.3390\/medicina60111862","article-title":"Acute coronary syndrome after aneurysmal subarachnoid hemorrhage: incidence, risk factors and impact on the outcome","volume":"60","author":"Me\u0161ka","year":"2024","journal-title":". Medicina"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e1819","DOI":"10.1212\/WNL.0000000000010618","article-title":"Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage","volume":"95","author":"Roquer","year":"2020","journal-title":"Neurology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s13054-025-05808-7","article-title":"Longitudinal trajectories of functional outcome following aneurysmal subarachnoid hemorrhage: a retrospective study","volume":"30","author":"De Trizio","year":"2026","journal-title":"Crit Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.3390\/medicina60111813","article-title":"The MARVIN hypothesis: linking unhealthy lifestyles to intracranial aneurysm rupture risk and clinical prognosis","volume":"60","author":"Swiatek","year":"2024","journal-title":"Medicina (B Aires)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"446","DOI":"10.3171\/2016.10.JNS16748","article-title":"Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis","volume":"129","author":"Dasenbrock","year":"2018","journal-title":"J Neurosurg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"3117","DOI":"10.1007\/s00701-020-04506-3","article-title":"Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage","volume":"162","author":"Sletteb\u00f8","year":"2020","journal-title":"Acta Neurochir (Wien)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.3171\/2021.3.JNS21293","article-title":"The influence of aneurysm morphology on the volume of hemorrhage after rupture","volume":"136","author":"Munarriz","year":"2022","journal-title":"J Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1161\/STROKEAHA.118.023902","article-title":"Prediction of outcome after aneurysmal subarachnoid hemorrhage","volume":"50","author":"Van Donkelaar","year":"2019","journal-title":"Stroke"},{"key":"B23","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.wneu.2024.05.032","article-title":"Global disparities in the presentation and management of aneurysmal subarachnoid hemorrhage: a review and analysis","volume":"187","author":"Lim","year":"2024","journal-title":"World Neurosurg"}],"container-title":["Frontiers in Radiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2026.1845453\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:46:50Z","timestamp":1782452810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2026.1845453\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":23,"alternative-id":["10.3389\/fradi.2026.1845453"],"URL":"https:\/\/doi.org\/10.3389\/fradi.2026.1845453","relation":{},"ISSN":["2673-8740"],"issn-type":[{"value":"2673-8740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"1845453"}}