Stent-assisted Coil Embolization Of Ruptured Aneurysms In The Acute Period: Incidence Of And Risk Factors For Hemorrhagic And Ischemic Complications

Objective:There are two kinds of serious complications related to hemorrhagic and ischemic complications in vascular endovascular stent in ruptured aneurysm,which can lead to poor clinical prognosis.This study is divided into two parts,and the potential risk factors of these two types of complications are analyzed in detail,and the causes of complications and the prevention and treatment of related adverse factors are discussed,so as to provide some reference for clinical treatment.Methods:We retrospectively collected the clinical and imaging data of patients with ruptured intracranial aneurysms from the Department of Neurosurgery at Tangdu Hospital of the Fourth Military Medical University from August 2014 to July 2017 and recorded the following data: gender,age,History of hypertension,preoperative Hunt-Hess grade,modified Fisher score,GCS score,number,location,size,shape of aneurysms,duration of aSAH to interventional treatment,number of stents inserted during interventional procedures,type,stent The release pattern,degree of aneurysm embolization,postoperative antiplatelet drug regimen,and perioperative lateral ventricle puncture and external drainage were used as the first part of the perioperative group with hemorrhagic complications.Cases with related complications as the second part of the case group were analyzed by univariate with the uncomplicated patients,and the influencing factors that could lead to complications were obtained.When P<0.05,the difference was statistically significant.The factor of P<0.05 in single factor was included in binary logistic regression analysis,and significant risk factors were obtained.Results:(The first part)This section included a total of 249 patients with ruptured aneurysms,of which 33 patients(13.2%)had perioperative hemorrhagic complications,including 8 cases(3.2%)of intraoperative aneurysmal burst bleeding,and postoperative aneurysmal rebleeding in eighteen cases(7.2%),postoperative non-aneurysm area or surgical operation area had new cerebral hemorrhage in 7 cases(2.8%).18 patients with aneurysm rebleeding had a very high mortality(83.3%,15/18).Univariate analysis showed preoperative Hunt-Hess grade(P=0.001),modified Fisher score(P=0.007),GCS score(P=0.021),single/multiple aneurysm(P=0.028),and the location of aneurysm(P=0.033)may be a contributing factor to hemorrhagic complications.Other factors(gender,history of hypertension,aSAH to interventional time,size of aneurysm,Raymond classification,postoperative medication regimen)and hemorrhagic complications were not statistically significant.Logistic regression analysis showed Hunt-Hess III-V(OR: 3.658,95%CI: 1.660-8.061,P=0.001),multiple aneurysms(OR: 2.667,95%CI: 1.178-6.036,P=0.019)were significant risk factors for hemorrhage.(The second part)This section included a total of 233 patients with ruptured aneurysms,of which 18 patients(7.7%)with perioperative ischemic complications,including 12 sudden acute thromboembolism(5.1%)and delayed postoperative cerebral ischemic in 6 examples(2.5%).Univariate analysis showed age(P=0.027),preoperative Hunt-Hess Grade(P=0.041),the location of aneurysm(P=0.048),stent release technique(P<0.001),postoperative drug(P<0.001)may be a contributing factor to ischemic complications.Other factors(gender,history of hypertension,preoperative modified Fisher scoring,GCS score,aSAH to the intervention operation time,the number of aneurysms,size,Raymond grade,the number of stent placement)and ischemic complications was not statistically significant.Logistic regression analysis showed Hunt-Hess III-V(OR: 4.332,95%CI: 1.010-18.582,P=0.049)and anterior communicating aneurysm(OR: 2.853,95%CI: 1.147-7.099).P=0.024)and tirofiban(OR: 106.441,95% CI: 21.396-529.526,P<0.001)were significant risk factors for the ischemic complications of intracranial aneurysms.Conclusion:The use of stent-assisted embolization in patients with ruptured intracranial aneurysms within 14 days of subarachnoid hemorrhage is a feasible and effective treatment.Clinical attention should be paid to perioperative hemorrhagic and ischemic complications,including intraoperative aneurysmal hemorrhage,postoperative aneurysm rebleeding,and postoperative non-aneurysm area with newly developed blood,acute thrombosis,and delayed postoperative cerebral ischemic and so on.The mortality rate of rebleeding after aneurysm surgery is extremely high,which seriously affects the prognosis of patients.Preoperative Hunt-Hess grades,modified Fisher scores,GCS scores,single/multiple aneurysms,and the location of aneurysm were the influencing factors for hemorrhagic complications.Hunt-Hess grades III-V and multiple aneurysms were significant risk factors for hemorrhagic.Age,preoperative Hunt-Hess grade,the location of aneurysm,stent release technique,postoperative drug were factors influencing ischemic complications.The application of tirofiban hydrochloride drugs needs to be combined with the condition.For the different clinical factors,the treatment needs to be personalized treatment according to the condition in order to reduce the occurrence of complications.