The Study On The Post-operative Ischemic Complication Factor In Ruptured Anterior Choroidal Artery Aneurysms

Objective: To analyze the clinical data of ruptured anterior choroidal artery aneurysms patients before and after surgical treatment(including clipping and coiling),to explore the risk factors of post-operative ischemic complications,and to summarize how to prevent and treat,so as to provide experience for clinical diagnosis and treatment.Methods: Retrospectively collected the clinical data of 58 patients who underwent head CTA or DSA in the first affiliated hospital of chongqing medical university(later referred to as "our hospital")and were identified as subarachnoid hemorrhage with anterior choroidal artery aneurysms and underwent microsurgical clipping orcoiling in our hospital,from September 2015 to June 2018.Patients were divided into two groups according to whether post-operative ischemic complications occurred.All patients were collected for risk factors,including preoperative baseline data,aneurysm-related information and intra-operative and post-operative treatment.Results: 1.The anterior choroidal artery aneurysms were completelyclipped or embolized by CTA or DSA within 1 week after surgery in both groups.Post-operative ischemic complications occurred in 20 patients,and the incidence of ischemic events was 34.5%.2.After univariate analysis,there were statistically significant differences such as: hunt-hess score(P=0.017),modified Fisher score(P=0.010),aneurysm size(5.5±2.5 VS 4.2±1.7,P=0.023)and the classification of anterior choroidal artery aneurysms(χ2=0.089,P=0.010)between the ischemic group and the non-ischemic group.However,there was no significant difference in age,gender,hypertension,diabetes,GCS score,aneurysm neck width,aneurysm number,surgery,operation time,and whether the internal carotid artery was blocked during the operation(P > 0.05).3.Logistic multiple regression analysis showed that hunt-hess score(P=0.013,OR=13.867,95%CI=1.749-109.919),aneurysm size(P=0.017,OR=5.389,95%CI=1.349-21.524)and the classification of anterior choroidal artery aneurysms(P=0.008,OR=7.861,95%CI=1.725-35.835)were important risk factors for post-operative ischemic complications.Conclusions: 1.The risk factors for post-operative ischemic complications of ruptured anterior choroidal artery aneurysms include hunt-hess grade ≥Ⅲ,aneurysm size > 5mm,and aneurysm arises completely or partially from the anterior choroidal artery.2.In the treatment of this type of aneurysms,pre-operative imagingexamination should be combined to fully understand the adjacent anatomy of aneurysm and vessels,and whether there is variation in the parent artery.Careful and gentle operation and appropriate intra-operative monitoring techniques can effectively reduce the incidence of ischemic complications.Timely review of imaging examination after surgery and protective individualized therapy are still helpful for improving the prognosis of patients.