Аннотация
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%, p < 0.001). In the representative 2021 referral cohort, the median interval from SAH onset to arrival at the tertiary neurovascular center was 26 days (IQR 9–54), reflecting substantial referral and transfer delays within the centralized healthcare system. In multivariable analysis, periprocedural complications (adjusted OR 8.68, p < 0.001) and ischemic heart disease (adjusted OR 3.07, p = 0.012) were independently associated with mRS 3–6, whereas higher admission Glasgow Coma Scale scores were protective (adjusted OR 0.64, p < 0.001). Aneurysm morphology and traditional SAH severity scales were not independently associated with long-term outcome. 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.