Risk Factors Of Complications And Recurrence For Endovascular Treatment Of Saccular Unruptured Intracranial Aneurysm

Part Ⅰ The Risk factors of neurological complications after endovascular treatment of Saccular Unruptured Intracranial AneurysmsObjective: We intend to explore the risk factors and clinical features of neurological complications(NCs)after the endovascular treatment(EVT)of Saccular Unruptured Intracranial Aneurysms(SUIAs),and to provide strategy for reducing the occurrence of neurological complications.Methods :Patients with SUIAs who underwent EVT in our center from January 2010 to Feburary 2017 were retrospectively collected and reviewed.The clinical and imaging features were analyzed with univariate analysis and multivariate logistic analysis to find the possible risk factors of NCs.Results: Of the 1232 consecutive patients with SUIAs who underwent endovascular treatment,NCs were detected in 60 patients(4.87%).Univariate analysis showed that hypertension(P=0.022),smoking(P=0.043),previous of transient ischemic attack(TIA)or cerebral infarction(CI)(P=0.000),cardiovascular comorbidities(P=0.001),aneurysm maximum diameter >10mm(P=0.000),irregular shape or have a daughter sac(P=0.010)and flow divert device(P=0.000)were associated with NCs(P<0.05).The multivariate analysis showed that previous of TIA or CI(P=0.000,OR=3.503),cardiovascular comorbidities(P=0.002,OR=3.290),aneurysm maximum diameter>10mm(P=0.000,OR=3.571)and irregular shape or have a daughter sac(P=0.019,OR=2.191)were independent risk factors of NCs.Conclusion: Previous of TIA or CI,cardiovascular comorbidities,aneurysm maximum diameter >10mm and irregular shape or have a daughter sac are independent risk factors of NCs after endovascular treatment of Saccular Unruptured Intracranial AneurysmsPart Ⅱ Risk factors and clinical features of intraprocedural rupture in endovascular treatment of Saccular Unruptured Intracranial AneurysmObjective: To explore the risk factors and clinical features of intra-procedural rupture(IPR)in the interventional treatment of Saccular Unruptured Intracranial Aneurysm(SUIA),so as to reduce the incidence of IPR.Methods: We retrospectively analyzed the clinical and imaging features of patients with SUIA who received interventional treatment in Changhai Hospital,Second Military Medical University from Jan.2010 to Mar.2017.Univariate and multivariate analysis were performed to analyze the risk factors of IPR.Results: A total of 1232 patients with unruptured aneurysms were included in this study.IPR occurred in 11 patients(0.89%).Univariate analysis showed that cardiac comorbidities(P=0.025),anterior communicating artery aneurysm(P=0.009),irregular morphology(P=0.001)and the use of stents(P=0.016)were significantly associated with IPR.Multivariate analysis showed that cardiac comorbidities(P=0.008,OR=6.919),irregular morphology(P<0.001,OR=9.758)and anterior communicating artery aneurysm(P=0.024,OR=4.648)were independent risk factors of IPR.Stents placement is protective factor of IPR(P=0.026,OR=0.238).Conclusion: Cardiac comorbidities,irregular morphology and anterior communicating artery aneurysm are independent risk factors of IPR in the endovascular treatment of SUIA.Stents placement is protective factor of IPR.Part Ⅲ Risk factors of procedural-related ischemic complications in the endovascular treatment of Saccular Unruptured Intracranial Aneurysms: a single center experience with 1232 aneurysms’ proceduresBackground and purpose: Ischemic complications(ICs)or thromboembolic events(TEE)is one kinds of frequent perioperative complications during endovascular treatment(EVT)to unruptured intracranial aneurysms(SUIAs),but the risk factors affected of it were unclear.We intend to analyzed the risk factors lead to ischemic complications during EVT of SUIAs.Methods: We retrospectively analyzed 1232 endovascular procedures on SUIAs from January 2010 to March 2017.Ischemic complication was defined as intra-procedural thrombosis,poster-operative transient ischemic attack(TIA),and postoperative symptomatic cerebral infarction(CI).Results: 34 EVT procedures occurred ischemic complications(2.76%,34/1232),Intraoperative thrombosis occurred in 16 patients(1.30%,16/1232),postoperative TIA occurred in 3 patients(0.24,3/1232),and cerebral infarction in 15 patients(1.22%,15/1312).Univariate analyses showed that the rate of ischemic complication was significantly higher in the patients with hypertension(P=0.002),smoking(P=0.050),aneurysm size>10 mm(P=0.005).Multivariate analyses show that hypertension(P=0.003,OR=3.192),smoking(P=0.022,OR=2.956)and aneurysm size>10mm(P=0.004,OR=2.915)were independently associated with ischemic complications during EVT of SUIAs.The rate of morbidity and mortality of ICs is 8.8%(3/34)and 2.9%(1/34)respectively.Conclusion: Hypertension,smoking and aneurysm size>10mm were risk factors to procedural-related ischemic complications during EVT of SUIAs.Part Ⅳ Analysis of the risk factors for postoperative recurrence of Saccular Unruptured Intracranial Aneurysms and digital subtraction angiography follow-up reportsObjective :To report the clinical and imaging follow-up results of Saccular Unruptured Intracranial Aneurysms(SUIAs)after endovascular treatment(EVT)and to explore the risk factors influencing the recanalization of it,in order to reduce the postoperative recurrence of aneurysms.Methods : We retrospectively collected patients with SUIAs who underwent EVT at Changhai Hospital of Second Military Medical University from January 2010 to December 2016 with complete follow-up data.Their clinical and radiographic features were collected and analyzed by single factor and Multivariate analysis of possible risk factors associated with postoperative recurrence.Results :A total of 537 consecutive patients were included in this study,56(10.4%)had postoperative recurrence.Univariate analysis showed that history of SAH(P = 0.038),the diameter of aneurysm> 10mm(P <0.001),neck width > 6mm(P <0.001),modadity of treatment(P=0.001)were associated with postoperative recurrence of SUIAs,while the multivariate analysis showed that the history of SAH(P = 0.004,OR = 4.361),aneurysm diameter> 10mm(P = 0.008,OR = 3.491),were independent risk factors of it.Compared with coiling,stent-assisted coiling(SAC)could reduce the risk of postoperative recurrence of Saccular Unruptured Intracranial Aneurysms(P <0.001,OR = 0.146).Conclusion :The history of SAH,aneurysm maximum diameter> 10 mm are independent risk factors of aneurysm recurrence.Compared with coiling,stent-assisted coiling can reduce the risk of postoperative recurrence of Saccular Unruptured Intracranial Aneurysms.