The Time Of Interventional Embolization And The Influencing Factors Of Prognosis In Patients With Hunt-hess Grade Ⅰ And Ⅲ Ruptured Intracranial Anterior Circulation Aneurysms

Objective:Objective to explore the best surgical timing of endovascular interventional embolization in patients with Hunt-Hess grade Ⅰ and Ⅲ ruptured intracranial anterior circulation aneurysms;By finding out the influencing factors of poor prognosis in patient with ruptured intracranial aneurysms,it can provide a clinical basis for patients to reduce the morbidity and mortality.Methods: A total of 110 patients with Hunt-Hess gradeⅠand Ⅲ ruptured intracranial anterior circulation aneurysms who underwent endovascular interventional embolization at affiliated hospital of youjiang medical university for nationalities from January 2019 to June 2021 were selected.The patients were divided into ultra-early group(<48h),early group(48-72h),and delayed group(>72h)according to the time from onset to interventional embolization.The NIHSS(National Institutes of Health Stroke Scale)scores at admission and2 weeks after endovascular embolization were compared among the three groups;the intraoperative and 3 months postoperative complications were recorded in each group;The GOS scale scores at 6 months after operation were compared.Using univariate analysis to select statistically significant factors,and then using Logistic multivariate regression analysis to identify its independent risk factors,and summarize the independent risk factors affecting the surgical prognosis of patients with anterior circulation RIA.Results:(1)The average NIHSS score on admission in the ultra-early group was 12.94±1.359 points,the average NIHSS score on admission in the early group was 12.87±1.457 points,and the average NIHSS score on admission in the delayed group was 13.00±1.518 points.There was no statistical difference in the preoperative NIHSS score between the three groups(F=0.055,P=0.947>0.05).The average NIHSS score 2 weeks after operation in the ultra-early group was 3.65 ± 0.729 points,the average NIHSS score in the early group 2weeks after operation was 3.60±0.737 points,and the average NIHSS score in the delayed group 2 weeks after operation was 5.64±0.764 points.The difference in NIHSS score was statistically significant.There was no significant difference in NIHSS scores between the ultra-early group and the early group at 2 weeks after operation(P=0.836>0.05).The NIHSS scores of the ultra-early group and the delayed group were compared 2 weeks after the operation,and the difference was statistically significant.The NIHSS scores of the early group and the delayed group were compared 2 weeks after the operation,and the difference was statistically significant.The incidence of aneurysm re-rupture was compared among the three groups during operation and 3 months after operation.Chi-square test was performed,x2=0.635,P=0.738>0.05,and the difference was not statistically significant.The incidence of hydrocephalus during the operation and 3 months after the operation was compared among the three groups,and the chi-square test was performed,x2=0.632,P=0.755>0.05,and the difference was not statistically significant.The incidence of cerebral infarction in the three groups during operation and 3 months after operation was compared,and the chi-square test was performed,x2=1.766,P=0.487>0.05,and the difference was not statistically significant.The incidence of pneumonia during the operation and 3 months after the operation was compared among the three groups,and the chi-square test was performed,x2=1.483,P=0.479>0.05,and the difference was not statistically significant.Among the 48 cases in the ultra-early group,41 cases had GOS 4-5 points,and 7 cases had GOS 1-3 points;among the15 cases in the early group,11 cases had GOS 4-5 points,and 4 cases had GOS 1-3 points;47cases in the delayed group,GOS 4-5 points in 36 cases,GOS 1-3 points in 11 cases.The prognosis of the three groups was compared,and the chi-square test was performed,x2=1.637,P=0.441>0.05.There was no significant difference in the good prognosis rate among the three groups.(2)The results of univariate analysis showed that seven items of Hunt-Hess grade,re-rupture of aneurysm,hydrocephalus,cerebral infarction,pneumonia,CT-Fisher grade,and age were significantly different between the good prognosis group and the poor prognosis group(p < 0.05);There was no significant difference between the good prognosis group and the poor prognosis group in terms of gender,hypertension,diabetes,smoking,drinking,ethnicity,aneurysm size,wide and narrow neck,ascus,aneurysm location,and operation timing(p>0.05).(3)Multivariate Logistic regression analysis showed: cerebral infarction(OR=22.060,95%CI=3.256-149.470,P<0.05),pneumonia(OR=7.680,95%CI=1.664-35.438,P<0.05),Hunt-Hess grade(OR=3.532,95%CI=1.025-12.167,P<0.05),the result was statistically significant,and it was an independent risk factor for poor prognosis of Hun-Hess I-III anterior circulation RIA.Conclusion:(1)This study shows that the timing of surgery is not a factor affecting the prognosis and complications of patients;early surgery(≤ 72h)is conducive to early neurological recovery;(2)There are many and complex factors affecting the prognosis of intracranial aneurysm surgery.Cerebral infarction,pneumonia,and length of hospital stay are independent risk factors for poor prognosis in patients with Hunt-Hess I-III anterior circulation RIA.In clinical work,individualized treatment of RIA patients should be adopted to minimize the occurrence of intraoperative or postoperative complications and shorten the length of hospital stay,in order to improve the prognosis of patients.