Analysis Of Factors Associated With Hyperperfusion Intracranial Hemorrhage After Angioplasty For Stenosis Of The Anterior Cerebral Circulation Artery

Objective:To investigate the risk factors for the occurrence of hyperperfusion intracranial hemorrhage(HICH)during the perioperative period after angioplasty treatment in patients with stenosis of the anterior cerebral circulation artery,and to provide a theoretical basis for clinical prevention of postoperative HICH.Methods:Patients attending the Affiliated Hospital of Qingdao University for vascular stenting treatment for anterior cerebral circulation artery stenosis from June 2019 to June 2022 were selected,and a total of 643 cases were selected according to the inclusion and exclusion criteria,and the patients’ general data,clinical symptoms,laboratory and imaging examination data,intraoperative imaging,perioperative blood pressure and medication were collected for retrospective analysis.The patients were divided into HICH group(n=14)and non-HICH group(n=629)according to the occurrence of HICH after surgery,and into 2 subgroups of extracranial arteries(extracranial segment of internal carotid artery)and intracranial arteries(including intracranial segment of internal carotid artery and middle cerebral artery)according to their stenosis sites and stent placement sites.Preoperative data [age,sex,BMI(body mass index),smoking history,previous history of ischemic stroke,diabetes mellitus,atrial fibrillation,ischemic heart disease,hypertension,types of antihypertensive drugs,platelets(PLT),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),creatinine(CR),admission symptoms and whether intensive anti platelet therapy],intraoperative data(mode of anesthesia,stenosis rate,treatment side,collateral circulation compensation,whether combined with severe stenosis of the contralateral carotid artery)and postoperative data(postoperative blood pressure status,whether postoperative hyperperfusion and intracranial hemorrhage)were statistically different,and factors with statistically significant differences(P<0.05)were subjected to multivariate logistic regression analysis to explore out the anterior circulation vascular independent risk factors for the occurrence of HICH after stenting for stenosis.Results:1.In a univariate analysis of the data of patients with stenting of cerebral artery stenosis in the total anterior circulation,statistically significant differences(P<0.05)were found between patients in the HICH and non-HICH groups in terms of gender,history of previous ischemic stroke,stenosis rate,whether they were hypertensive postoperatively,and degree of compensation of the collateral circulation.Multi-factor logistic regression analysis of the above factors showed that female(OR=4.991,95% CI:1.399-17.807),history of previous ischemic stroke(OR=4.149,95% CI:1.180-14.588),high stenosis rate(OR=1.129,95% CI:1.016-1.255)and postoperative hypertension(OR=10.320,95%CI:2.169-49.104)were independent risk factors for the development of HICH,and good collateral circulation(OR=0.112,95%CI:0.028-0.450)was a protective factor.2.In a univariate analysis of the extracranial artery subgroup,statistically significant differences(P<0.05)were found between the HICH and non-HICH groups in terms of gender,stenosis rate,whether or not they were hypertensive postoperatively,and degree of collateral circulation compensation.Multifactorial logistic regression analysis of the above factors showed that the high stenosis rate(OR=1.149,95% CI:1.002 to 1.318)and postoperative hypertension(OR=11.085,95% CI:1.299 to 94.586)were independent risk factors for the development of HICH,and good collateral circulation(OR=0.184,95% CI:0.035 to 0.966)was a protective factor.3.In a univariate analysis of the intracranial artery subgroups,statistically significant differences(P<0.05)were found between patients in the HICH and non-HICH groups in terms of whether they had postoperative hypertension and the degree of collateral circulation compensation.Multifactorial logistic regression analysis of the above factors showed that postoperative hypertension(OR=9.465,95% CI:0.995-90.011)was an independent risk factor for the development of HICH and good collateral circulation(OR=0.086,95% CI:0.009-0.812)was a protective factor.Conclusion:In patients treated with stenting for total anterior circulation cerebral artery stenosis,female gender,history of ischemic stroke,high stenosis rate and postoperative hypertension were independent risk factors for the development of HICH,and good collateral circulation was a protective factor.In patients treated with stenting for extracranial artery stenosis,high stenosis rate and postoperative hypertension were independent risk factors for postoperative HICH,and good collateral circulation was a protective factor.In patients treated with stenting for intracranial artery stenosis,postoperative hypertension is an independent risk factor for postoperative HICH,and good collateral circulation is a protective factor.Therefore,patients with the above risk factors should be taken seriously in clinical treatment,and individualized treatment plans should be formulated according to their conditions,and patients’ perioperative blood pressure and new symptoms after surgery should be closely monitored to avoid adverse events.