Related Risk Factors Analysis Of Sent Assisted Coil Embolization In Treatment Of Acute Ruptured Intracranial Wide Necked Aneurysms And Construction Of Nomogram Prediction Model

Background:Intracranial aneurysms(IAs)are pathological dilations at an arterial bifurcation of major branching brain arteries,mainly in the circle of Willis and its main branches.Wide-necked aneurysms(WANs)are a subset of aneurysms with a neck width greater than 4 mm or a dome-to-neck ratio of less than 2.Over time,IA has a tendency to spontaneously rupture and bleed.Aneurysmal subarachnoid hemorrhage(a SAH)can result from the rupture of an IA aneurysm.Although a SAH accounts for only 3% of all stroke types,it has a high complication rate and mortality.For the treatment of ruptured IA,microsurgical clamping and endovascular intervention are the two common surgical approaches.With the rapid development of interventional materials and techniques,more and more studies have shown that endovascular interventions are superior to surgical clipping.Stent-Assisted Coiling(SAC)has an important role in the treatment of wide neck,microscopic and giant aneurysms,which are difficult to be treated in all kind of IA.The use of stenting can effectively reduce the risk of coil herniation into the parent vessel,and the radial support provided by the stent allow dense packing of the aneurysm lumen,reducing the recanalization and recurrence rate of IA.Especially for acute stage of WAN,the use of stents increases the probability of ischemic and hemorrhagic complications,which may cause patient death in severe cases.Therefore,evaluating the risk of complications of SAC treatment of WAN in the acute phase is important for the perioperative management and prognosis of patients.Objective:In this study,we analyzed the clinical characteristics of ruptured WAN,screened independent risk factors by univariate and multifactorial analyses,constructed a nomogram model predicting complications in WAN treated with SAC in the acute stage based on independent risk factors and internally validated the model,and provided reference for individualized clinical decision making by surgeons in the futureMethods: This is a retrospective study,by collecting a total of 290 patients with complete clinical data who attended the neurosurgery department of Subei People’s Hospital between September 2013 and June 2022 and underwent SAC for WAN in the acute phase.Patient data were collected: including patient age,gender,history of hypertension,preoperative head CT results or head MRI results,preoperative Hunt-Hess classification,preoperative GCS score,preoperative Fisher score,aneurysm size,location,number,whether the parent vessel was stenosed,stent type,stent number,stent release mode,stent release status,Raymond classification,operative time length,intraoperative imaging results,postoperative cranial CT results and or postoperative MRI results,platelet aggregation function at 3 days postoperatively,AA and ADP inhibition rate,and discharge m RS score.The 290 cases were randomly divided into a training group and an internal validation group according to 7:3,with 203 cases in the training group and 87 cases in the internal validation group.The independent risk factors were screened out by univariate analysis and multivariate Logistic regression analysis on the training set with SPSS 25.0,and the Nomogram model were constructed using the rms package in RStudio based on the screened independent risk factors.Operating Characteristic(ROC)and calibration curve were plotted separately to verify the model discrimination and calibration.Finally,the Decision Curve Analysis(DCA)were used to determine the clinical decision making ability of the Nomogram model.In this study,P < 0.05 was considered as statistically different.Results: The overall complication rate of WAN treated with SAC in the acute phase was found to be 20.2%(41/203)after univariate analysis of the training set of 203 cases,of which the probability of ischemic complications was 15.8%(32/203)and bleeding complications was 4.4%(9/203)in our study.Univariate analysis showed age(χ2=6.380,P=0.012),degree of stenosis of the aneurysm-carrying artery(χ2=8.283,P=0.004),mode of stent release(χ2=10.343,P =0.001),whether the stent was fully apposed to the wall(χ2=8.283,P =0.004),GCS score(χ2=15.441,P < 0.001),Hunt-Hess grading(χ2=10.517,P =0.001),discharge m RS score(χ2=10.407,P =0.001),and Raymond grading(χ2=9.175,P =0.010)were correlated with the occurrence of WAN complications in the acute phase of SAC treatment(P<0.05).Multivariate Logistic regression analysis of factors with correlation found age ≥65 years(P =0.021,OR=2.721,95% CI: 1.164-6.360),degree of stenosis of >50% in the aneurysm-carrying artery(P=0.030,OR=9.289,95% CI:1.240-69.561),mode of stent semi-release(P =0.007,OR=3.597,95%CI:1.427-9.070),and GCS score of 9-14(P =0.027,OR=3.113,95%CI:1.141-8.495)were independent risk factors for complications in the acute phase of SAC treatment of WAN.The area under the ROC curves of the training and validation sets under the model was calculated as 0.743(95% CI: 0.698-0.867,P < 0.05)and 0.773(95% CI: 0.622-0.846,P < 0.05),respectively,using the above four independent risk factors to draw the Nomogram prediction model,suggesting that the model has good discrimination and good predictive ability.The calibration curves were drawn by Bootstrap resampling method with 1000 resampling,and the fitted curves oscillated around the 45° reference line,showing a high degree of calibration;the DCA curves were drawn and analyzed,showing that the domain probability was between 10% and 80% of the net benefit,suggesting that the model has good clinical application value.Conclusion: The overall complication rate of the acute stage SAC treatment WAN was 20.2%,with a 15.8% probability of ischemic complications and a 4.4% probability of bleeding complications.Age,degree of stenosis of the parent vessel,stent release method,whether the stent was completely walled,GCS score,Hunt-Hess score,discharge m RS score,and Raymond classification were correlated with the occurrence of complications.Age ≥65 years,stenosis of >50% of the parent vessel,stent semi-release method,and GCS score of 9-14 were the independent risk factors for the development of complications.The prediction model based on the above four independent risk factors has good predictive efficacy,which can provide a certain degree of reference and guidance for the prevention of complications associated with SAC treatment in the acute phase of WAN.