Comparison Of The Efficacy Of Stent-assisted Spring-ring Embolization In Intracranial Ruptured Aneurysms With Different Surgical Timing And Analysis Of The Factors Influencing Prognosis

Objective:To compare the efficacy of stent-assisted spring coils in intracranial ruptured aneurysms at different surgical timing and to analyse the factors affecting prognosis.Methods:Clinical data were collected from patients with intracranial ruptured aneurysms treated with stent-assisted spring coil embolization within 72 h of onset at the Second Affiliated Hospital of Nanchang University between January 1,2021 and June 30,2022.All patients who met the criteria were divided into two groups,those treated within 24 h as the ultra-early group and those treated between 24 h and 72 h as the early group.The clinical prognosis(measured using the modified Rankin Scale(m RS)),perioperative complications,immediate and postoperative follow-up occlusion(assessed using the Raymond scale)were studied in both groups.Results:All 116 cases of acute rupture of intracranial aneurysms were treated with stent-assisted spring coils within 72 hours,58(50%)of which were treated at an ultra-early stage(≤24h)and 58(50%)at an early stage(24-72h).There were no statistical differences between the two groups in terms of age,gender,history of hypertension,preoperative Fisher CT classification,Hunt-Hess classification,aneurysm characteristics,number of stents and stent type.The difference was statistically significant between the two groups in terms of good clinical outcomes(m RS 0-2)at six-month postoperative follow-up in 52(89.7%)and 42(72.4%)patients,respectively.The results of the univariate analysis of the above data suggested that history of hypertension,preoperative Hunt-Hess classification,preoperative Fisher CT classification and time of surgery were relevant influencing factors on prognosis.Multi-factor logistic regression analysis of the above influencing variables showed that preoperative Hunt-Hess classification(OR7.12295%CI 2.238-22.663 P=0.001),preoperative Fisher CT classification(OR5.31595%CI 1.553-18.189 P=0.008)and ultra-early treatment(OR5.856 95%CI 1.662 to20.635 P=0.006)as their independent influencing variables.A total of 10 patients(8.6%)had perioperative complications,of which 3 patients(5.1%)had perioperative complications in the ultra-early(within 24h)group and 7 patients(12.0%)had perioperative complications in the early(within 24-72 hours)group.Immediate angiography showed complete occlusion in 91.3% and 93.1% of patients respectively,with no statistically significant difference between the two groups.A total of 60 cases(51.7%)came to the hospital for repeat angiography.30(93.8%)of complete occlusions were ultra-early and 27(96.4%)were early,with no statistically significant difference.Conclusion:Ultra-early stenting of ruptured intracranial aneurysms has a better prognosis than early stent-assisted spring coil treatment,reducing the likelihood of rebleeding and not increasing the incidence of postoperative complications or postoperative recurrence.The preoperative Humt-Hess score and preoperative Fisher CT classification were independent factors affecting the prognosis of ultra-early versus early surgery.