| OBJECTIVE The purpose of this study aims to summarize the incidence of nervous system related events and the adverse events in the treatment of intracranial wide-neck aneurysms with SACE,and to explore the relevant factors leading to adverse events in hospital,which can provide clinical evidence for the prevention and treatment of neurological adverse events during the perioperative period.METHODS we retrospectively searched our clinical data base for 227 patients with intracranial wide-neck aneurysms who had undergone endovascular aneurysm treatment with stent-assisted coil embolization in our institution(Department of Neurology,First Affiliated Hospital of Guangxi Medical University)between January 2015 to December 2019.The time of neurological events found after stent-assisted coiling were reviewed,and the clinical manifestations and other relevant clinical data were also reviewed.According to the discharge and admission m Rs scores,they were divided into the adverse events group(30 cases)and the non-adverse events group(197 cases).Univariate analysis was used to compare the general conditions,clinical manifestations,imaging data,biochemical data and other variables of the two groups.The binary logistic regression analysis was performed on the statistically different data to find independent related factors that may lead to adverse events in hospital.RESULT(1)In 227 cases of intracranial wide-neck aneurysms treated with stent-assisted coil embolization,there were 30 cases of adverse events,and the incidence of adverse events was 13.2%(30/227).In addition,the incidence of neurological events was 25.1%(57/227),of which 52.6%(30/57)led to adverse events.50.9% of patients found neurological-related events within 6.72 hours during or after stent-assisted coil embolization,and 93% of patients found neurological-related events within 24 hours during or after stent-assisted coil embolization.Among them,8.8%(5/57)were found during the operation(including intraoperative aneurysm rupture and coil escape).66.7%(38/57)were accompanied by decreased muscle strength,and 28.1%(16/57)were accompanied by changes in consciousness,22.8%(13/57)were accompanied by aphasia or dysarthria,and 15.8%(9/57)were combined with other manifestations.(2)The incidence of neurological bleeding-related events was 7.0%(16/227),including intraoperative rupture 1.76%(4/227),postoperative rebleeding 2.64%(6/227),postoperative cerebral hemorrhage 2.64%(6 /227),of which 68.75%(11/16)lead to adverse events.The incidence of neurological ischemia-related events was 18.1%(41/227),of which 46.3%(19/41)caused adverse events.All in all,the incidence of hemorrhage-related events leading to adverse events was4.85%(11/227),the incidence of ischemia-related events leading to adverse events was 8.37%(19/227),and hospital death(1 case,0.44%)or the incidence of automatic discharge from hospital in deep coma(4 cases,1.76%)was 2.2%(5/227).(3)The results of binary regression analysis showed that the two groups of patients in admission m Rs score(P=0.021),neck diameter(P=0.015),parent vessel diameter(P=0.010),ratio of neck diameter to parent vessel diameter(P=0.004),ratio of perpendicular height to parent vessel diameter(P=0.031),the degree of stenosis of the parent vessel(P=0.043),aneurysm location(P=0.001),and the ratio of postoperative creatinine to preoperative creatinine(P=0.022),postoperative anticoagulation therapy(P=0.026)were significantly different.(4)The results of binary logistic regression analysis showed that patients admitted to the hospital with m Rs scores 3-4 points were 13.651 times more likely to have adverse events than patients with 0-1 points(OR=14.651,95% CI of OR=2.816-76.212,P=0.001);patients with a history of SAH are 18.769 times more likely to have adverse events than patients without SAH(OR=19.769,95% CI of OR=3.179-122.940,P=0.001);no anticoagulant therapy are used after surgery compared with the postoperative use of anticoagulation,the incidence of adverse events is 26.229 times higher(OR=27.229,95% CI of OR=1.790-414.158,P=0.017).The probability of adverse events for each increase in the size of the aneurysm neck increases by 0.337 times(OR=1.337,95% CI of OR=1.112-1.608,P=0.002),the smaller the parent vessel size is(OR=0.386,95%CI of OR=0.211-0.706,P=0.002),the smaller the ratio of the aneurysm height to the diameter of the parent vessel(OR=0.487,95%CI of OR=0.241-0.983,P=0.045)and the lower the value of low-density lipoprotein(OR=0.555,95%CI of OR= 0.327-0.941,P=0.029),the higher the risk of occurrence of adverse events.Therefore,the admission m Rs score of 3-4 points,a history of SAH,a large aneurysm neck size,a small parent vessel diameter,a small ratio of aneurysm height to parent vessel diameter,and a low low-density lipoprotein value may be risk factors for adverse events in stent-assisted endovascular treatment of intracranial wide-necked aneurysms.CONCLUSION(1)Stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms has an adverse events rate of 13.2%(30/227).Nervous system ischemia events and bleeding events are important factors leading to adverse events,and they mainly occur in within 24 hours during or after operation.(2)Admission m Rs score 3-4 points,previous history of SAH,large aneurysm neck size,small parent vessel diameter,small ratio of aneurysm height to parent vessel diameter,lower low-density lipoprotein value may be important factors for adverse events in stent-assisted endovascular treatment of intracranial wide-necked aneurysms. |
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