The Safety And Effectiveness Of Stent-assisted Coil Embolization In Acutely Ruptured Wide-necked Intracranial Aneurysms:A Single Center Research

BackgroundIntracranial aneurysm rupture is the third risk factor for stroke.Most intracranial aneurysms occur in people aged 40-60,with an incidence of about 3%,a natural rupture rate of about 1-2%,and acute mortality can be up to 50%,early intervention treatment can significantly improve the prognosis of patients.In 2015,the International subarachnoid aneurysm trial(ISAT)confirmed that the treatment of unruptured intracranial aneurysms through stent-assisted coil treatment is safety and effectiveness,and intravascular treatment of unruptured intracranial aneurysms has become the mainstream treatment method.There is a lot of controversy about this.Some previous studies have reported that the stent-assisted coil embolization uesd in ruputured intracranial aneurysm in acute period will increase the complication rate and mortality of patients,and some studies have reported that the acute intracranial rupture has a wide neck.The treatment of aneurysms with stent-assisted coils is a safe and feasible way.At present,there are not many domestic studies on stent-assisted embolization of ruptured wide-necked intracranial aneurysms in the acute stage,and there is no clear guideline the stent-assisted coil embolization uesd in ruputured intracranial aneurysm in acute period is safety and effectiveness.Through the collection of patients with intracranial aneurysms treated with stent-assisted coil embolization in the past five years from the Department of Neurovascular Surgery of Zhujiang Hospital,and divided into unruptured group and ruptured group,through understanding the complications and follow-up,assess the ruptured group and the unruptured group The differences in complications and recurrence rates between the groups,to evaluate the safety and effectiveness of the treatment in this study,are reported as follows.ObjectiveTo explore the safety and effectiveness of the treatment of intracranial ruptured wide-necked aneurysms in acute period through stent-assisted embolization coils.MethodsThe clinical data of 249 patients with 301 aneurysms who treated with stent-assisted coils were collected from January 2014 to December 2018 in the Department of Cerebrovascular Surgery of Zhujiang Hospital,and then divided into rupture group(SAC)./RIA)(114 cases)and unruptured group(SAC/UIA)(135 cases),to compare and analyze the difference in baseline information between the ruptured group and the non-ruptured group,the complications of aneurysm rupture,intraoperative and postoperative Complications of intravascular thrombosis,differences in mortality and recurrence rates,and the modified Rankin Scale Score(mRS)are used to assess the postoperative conditions of patients and compare related factors,covering the patient’s age,gender,history of hypertension,and diabetes History,mRS score during hospitalization,size of aneurysm,location of aneurysm,whether aneurysm is frequent,treatment time and degree of embolism.Single factor and binomial logistic regression analysis of risk factors affecting clinical prognosis and recurrence.ResultsBetween the stent-assisted coil embolization in ruptured wide-necked intracranial aneurysms(SAC/RIA)group in acute period and the stent-assisted coil embolization in unruptured wide-necked intracranial aneurysms(SAC/UIA)group,procedure-related complications were slightly higher than in the SAC/RIA group than in the SAC/UIA group(10.5%vs 6.6%),whereas there was no difference in the between the SAC/RIA group and the SAC/UIA group(P=0.28).In a logistic analysis,there were significant differences among patients with hypertension(OR,3.85;95%CI,1.18-12.55 P=0.03),aneurysms lager than 10 mm(OR,11.2;95%CI,0.63-38.36 P=0.002).211 patients(84.7%)with a median period of 7 months(range,1-52 months)were got the angiographic follow-up.Aneurysms recurrence occurred between SAC/RIA group and the SAC/UIA group were comparable(9.6%vs 12.8%,χ2 value,P=0.55).In a logistic analysis,the aneurysm recurrence rate differed significantly among patients with aneurysms lager than 10 mm(OR,9.47;95%CI,0.96-93.20;P<0.001),and Raymond class Ⅲ initial aneurysm occlusion(OR,51.34;95%CI,4.26--619.07;P=0.002),Raymond class Ⅱ initial aneurysm occlusion(OR,14.94;95%CI,4.03--55.43;P<0.001).ConclusionThe incidence of perioperative complications and the recurrence rate were shown no significant differences in the follow-up between the two groups,indicatied that the safety and effectiveness of the treatment of acute intracranial rupture wide-necked aneurysms through stent assisted embolization.Patients with hypertension,aneurysm size of 10 mm is an independent risk factor for perioperative complications,and patients with aneurysms larger than 10 mm and incomplete embolization of the aneurysm are independent risk factors for postoperative recurrence.