Long Term Follow-up And Retrospective Analysis Of Intravascular Interventional Treatment Of Internal Carotid Artery Posterior Communicating Segment Aneurysms

Background:The rupture of the intracranial aneurysm is the third risk factor for stroke.Aneurysmal subarachnoid hemorrhage caused by aneurysm rupture which is high incidence,wide range and poor prognosis in population.It is a cerebrovascular disease which seriously endangering human health.Posterior communicating artery aneurysm refers to the aneurysm located in the posterior communicating segment of internal carotid artery.It is one of the most common intracranial aneurysms,accounting for about 25% of intracranial aneurysms.The anatomical location of posterior communicating artery aneurysm is special,Compared with the rupture risk of middle cerebral artery aneurysm or other segments of internal carotid artery,it has a higher risk of subarachnoid hemorrhage.Intravascular interventional therapy has become the mainstream treatment of posterior communicating aneurysms,but its high recurrence rate affects the overall treatment effect.The factors affecting aneurysm recurrence may be affected by the degree of aneurysm embolization,the size of aneurysm body,the width of aneurysm neck,whether to use stent and so on.This study evaluated whether the degree of postoperation embolization and long-term follow-up embolization are related to the recurrence of aneurysms,and whether the use of stent assisted embolization and simple coil embolization are related to the recurrence,so as to evaluate the effectiveness of posterior communicating artery aneurysm after intravascular intervention.Objective: This study adopted a retrospective analysis of patients diagnosed with posterior communicating aneurysms in the Department of Neurosurgery of the Second Affiliated Hospital of the Army Military Medical University,collected and analyzed the general physical state and imaging data,and discussed the efficacy of intravascular interventional treatment of posterior communicating aneurysms,risk factors affecting recurrence,so as to provide reference basis for clinical work in the treatment of posterior communicating aneurysms.Methods: The information of patients with posterior communicating artery aneurysms diagnosed in neurosurgery of the Second Affiliated Hospital of the Army Medical University from January 2011 to December 2015 were collected and followed up for more than 3 years,all patients were treated with intravascular interventional therapy.Collect the data of patient’s gender,age and the location,size,orientation,incidence angle of the aneurysm,whether it is a wide necked aneurysm,whether it is a regular aneurysm,whether it is ruptured,whether it uses stents,the degree of immediate postoperative embolization,the degree of follow-up embolization,history of hypertension,etc.analyze and summarize the collected data,Statistical software R(version 4.1.1;R core team,2021)is used for statistical description and inference.Quantitative data are expressed by means and standard deviation,and qualitative data are expressed by frequency and percentage.T-test,one-way ANOVA and multivariate logistic regression model were used to further explore the relevant influencing factors of each outcome variable.Results: the average age of 80 patients was 53.26 ± 8.90 years old,including 15 males(18.8%)and 65 females(81.2%).There were 29 small aneurysms(36.2%),45 medium aneurysms(56.2%),6 large and above aneurysms(7.5%),48 wide necked aneurysms(60.0%),32 non wide necked aneurysms(40.0%),22 unruptured aneurysms(27.5%)and 58 ruptured aneurysms(72.5%).In the treatment,37 cases of patients treated with simple coil embolization and 43 cases of patients treated with stent assisted coil embolization,all of them were successfully treated with intravascular interventional therapy.The degree of immediate embolization after operation:41 cases of Raymond grade 1(51.2%),21 cases of Raymond grade 2(26.2%)and 18 cases of Raymond grade 3(22.5%).The degree of long term follow-up embolization showed: Raymond grade 1 in 51 cases(63.7%),Raymond grade 2in 25 cases(31.2%),Raymond grade 3 in 5 cases(5.0%).Aneurysms recurred in 10 cases(12.5%)and did not recur in 70 cases(87.5%)after treatment.In univariate analysis,patients’ age(= 4.344,P = 0.016),aneurysm size(= 10.725,P = 0.03),wide necked aneurysm(= 6.700,P = 0.035)and stent assisted treatment of aneurysms(= 5.018,P = 0.041)were the influencing factors of the degree of postoperative immediate embolization of posterior communicating artery aneurysm;Whether it is a wide necked aneurysm(= 7.104,P = 0.029)and the degree of immediate postoperative embolization(=-,P = 0.049)are the influencing factors of long-term follow-up embolization degree of posterior communicating aneurysms;Aneurysm size(= 6.309,P = 0.013),whether the aneurysm is a wide necked aneurysm(= 7.874,P = 0.035),the degree of postoperative immediate embolization(= 13.921,P = 0.016)and whether the aneurysm is treated with stent(= 10.005,P = 0.048)are the influencing factors for the recurrence of posterior communicating artery aneurysm.Ordered logistic regression model showed that the related factors of the degree of embolization density immediately after operation included the size of aneurysm,whether it was wide neck,whether it was regular,and whether there was stent assisted treatment.The related factors of the degree of embolization density in long-term follow-up were whether it was wide neck,whether there was stent assisted,and the degree of immediate embolization density;Multivariate logistic regression model showed that the size of aneurysm and whether stent assisted aneurysm recurrence were statistically significant.Conclusion: 1.After intravascular interventional treatment,the density of medium-sized,wide neck,irregular posterior communicating aneurysms and posterior communicating aneurysms without stent assisted embolization is lower immediately after operation;The posterior communicating aneurysms with wide neck and low degree of immediate dense embolization after operation and those without stent adjuvant treatment had lower degree of dense embolization in the long-term follow-up.2.Posterior communicating aneurysms with medium and large size,wide neck and no stent assisted embolization are more likely to recur after operation;The higher the density of immediate embolization after operation,and the posterior communicating aneurysm with stent adjuvant treatment is not easy to relapse.