Analysis Of Treatment Complications And Risk Factors Of Ruptured Middle Cerebral Artery Aneurysms

Objective: To analyze the main treatment complications and risk factors of Middle cerebral artery aneurysms(MCAAs),so as to provide references for the treatment and prevention of complications of MCAAs.Methods: A total of 552 patients with ruptured middle cerebral artery aneurysm treated and discharged from Tianjin huanhu hospital from January 2010 to December2019 were retrospectively analyzed.To summarize the major treatment complications during the treatment,risk factors that may be related to the occurrence of complications were screened and determined as independent variables,such as the patient’s age,gender,previous disease history,personal history,SAH frequency and grade,aneurysm location,size and treatment received.Then the perioperative complications were used as the dependent variable.A single factor analysis of each factor will be carried out first to test whether it actually affects the complications.Then,the risk factors with statistical significance were included in the logistic multivariate analysis model,and the statistical software SPSS24 was used for multivariate logistic regression analysis calculation to analyze and screen the risk factors that might influence the perioperative complications of ruptured MCAAs.Results: A total of 552 patients were included in this study,including 24 patients with complications,with a complication rate of 4.35%.The results of single factor analysis showed that the history of hypertension(P=0.046),the history of TIA/ cerebral infarction(P < 0.001),the location of aneurysm(P=0.015),the size of aneurysm(P=0.012),the Hunt-Hess classification(P < 0.001),and the modified Fisher classification(P < 0.001)were the relevant factors for the occurrence of treatment complications.Multivariate logistic regression analysis suggested that history of hypertension(P=0.046),history of TIA/ cerebral infarction(P < 0.001),aneurysm location(P=0.011),aneurysm size(P=0.043),Hunt-Hess classification(P < 0.003),and modified Fisher classification(P =0.002)were independent risk factors for treatment complications.Conclusions:1.TIA/cerebral infarction history,aneurysm location,aneurysm size,Hunt-Hess grade and modified Fisher grade are independent riskfactors for treatment complications in patients with ruptured MCAAs.2.Interventional embolization of aneurysms is a reasonable choice for elderly patients with ruptured MCAAs who cannot tolerate general anesthesia and clipped by craniotomy.3.For patients with complex aneurysms and difficult to manage,intraoperative vascular Doppler ultrasound,intraoperative indocyanine green angiography,electrophysiological monitoring and intraoperative DSA can be used to reduce ischemic events.4.There is a higher risk of ischemic complications in patients with cerebrovascular stenosis.5.For vasospasm,the prophylactic application of "3H therapy" proposed in the past is not recommended.After aneurysm operation,multiple lumbar puncture can release cerebrospinal fluid to remove subarachnoid hemorrhage,which is helpful to improve symptoms and reduce the occurrence of cerebral vasospasm.