Risk Factors And Follow-up Study Of Complications Of Tiny Intracranial Saccular Aneurysms Treated By Endovascular Neurointervention

Part Ⅰ Analysis of the risk factors of neurological complications in endovascular neurointerventional treatment for tiny intracranial saccular aneurysmsObjective:The data of tiny intracranial aneurysms included in the study were analyzed from the basic information of patients,aneurysms,treatment strategy,and postoperative immediate.To analyze the risk factors of neurological complications in tiny intracranial saccular aneurysms in endovascular neurointerventional treatment,and clinically can avoid the relevant risk factors,thereby reducing the incidence of neurological complications.Methods:The clinical data of patients with tiny intracranial saccular aneurysm who underwent endovascular neurointerventional therapy from January 2006 to May 2018 were retrospectively collected.The inclusive criteria were as follows:1.age≥18 years old;2.Intracranial aneurysms were confirmed by CTA and/or MRA and cerebral angiography;3.The maximum diameter of aneurysm is less than 3mm.Exclusion criteria:1.Non cystic aneurysms,such as fusiform aneurysms,dissecting aneurysms,pseudoaneurysms,traumatic aneurysms,infectious aneurysms;2.The minimum diameter of aneurysm was more than 3 mm;3.With other vascular abnormalities except aneurysm,such as vascular malformation,arteriovenous fistula,moyamoya disease,aneurysm caused by malignant tumor;4.Intracranial hemorrhage and/or symptomatic cerebral infarction within 6 months of unruptured aneurysm;5.Recurrent aneurysms after endovascular interventional therapy or craniotomy;6.Aneurysms with incomplete data.Adopt simple coil embolization technique or simultaneously apply auxiliary technique embolization treatment.Collect factors related to aneurysm:irregular aneurysm,aneurysm neck width,whether the aneurysm is a wide-necked or narrow-necked aneurysm,multiple aneurysms,aneurysm volume,aneurysm location.Collect patient-related factors:including age,gender,previous history of hypertension,diabetes,symptomatic stroke,smoking,drinking,and cardiovascular history.Collecting factors related to the surgical operation include:whether the treatment plan is single microcatheter embolization or embolization using assistive technology(such as stent assisted embolization,coils,balloon assisted embolization,microcatheter assisted embolization,microwire assisted embolization,multiple microcatheters Embolization technique).Single-factor and multi-factor statistical analysis of clinical and imaging characteristics were used to study possible neurological complications risk factors.Results:In 459 cases of tiny intracranial aneurysm,208 cases(47.3%)had history of hypertension,41 cases(9.3%)had diabetes mellitus,89 cases(20.2%)of smoking history,99 cases(22.5%)of drinking history,16 cases of 3.6%history of symptomatic cerebral vascular disease(3.6%),and 22.5%cases of cardiovascular disease(3.6%).The width of aneurysm neck was 2.26±48mm,442(96.3%)wide necked aneurysms and 17(3.7%)narrow necked aneurysms.There were 52 ruptured aneurysms(11.3%);There were 407 unruptured aneurysms(388 patients)(88.7%).192 cases(43.6%)had multiple aneurysms and 267 cases(56.4%)had non multiple aneurysms.Location of aneurysms:144(31.4%)in anterior cerebral artery system,There were 99(21.6%)middle cerebral artery system,181(39.4%)internal carotid artery system and 35(7.6%)posterior circulation aneurysms.Surgical strategy:231 aneurysms(50.3%)were embolized with single microcatheter,56 aneurysms(12.2%)were embolized with stent-assited technique,51 aneurysms(11.1%)were embolized with balloon-assited technique,35 aneurysms(7.6%)were embolized with multiple microcatheter,63 aneurysms(13.8%)were protected with microcatheter,23 aneurysms(5.0%)were protected with microcatheter.According to Raymond classification,192 cases(41.8%)were Raymond Ⅰ,230 cases(50.1%)were Raymond Ⅱ and 37 cases(8.1%)were Raymond Ⅲ.The immediate postoperative satisfaction of single microcatheter group was lower than that of stent assisted group,microcatheter protection group,balloon assisted group and multiple microcatheter group(P=0.001),and there was no difference between single microcatheter group and micro guide wire group(P=0.920).Among 459 cases of tiny intracranial aneurysms,41 cases(8.9%)had neurological complications,and 418 cases(81.1%)had no neurological complications.The results of univariate analysis of various related factors showed:history of hypertension(P=0.029),history of smoking(P=0.033),history of drinking(P=0.047),irregular shape(P=0.019),ruptured aneurysm(P=0.011),aneurysm volume(P=0.039),located in the internal carotid artery system(P=0.020),application of stent-assisted embolization(P=0.045),immediate postoperative embolization satisfaction assessment Raymond Ⅲ(P=0.009)are related with neurological complications.Multivariate results showed:previous history of hypertension(P=0.041,OR=2.340),history of smoking(P=0.049,OR=1.996),irregular shape(P=0.019,OR=3.005),ruptured aneurysm(P=0.001,OR=3.873)are the independent risk factors related with neurological complications.Conclusion:Hypertension history,smoking history,irregular aneurysm shape,ruptured aneurysm,immediate postoperative embolization satisfaction Raymond grade Ⅲ were independent risk factors for neurological complications of tiny intracranial aneurysms.The satisfaction degree of immediate embolization after application of auxiliary technology(stent assisted embolization,microcatheter protection,balloon protection,multi microcatheter embolization)is better than that of single microcatheter embolization.Part Ⅱ Analysis of risk factors of bleeding complications during endovascular interventional treatment of tiny intracranial saccular aneurysmsObjective:To analyze the risk factors for the complications of rupture and bleeding of tiny intracranial saccular aneurysms during endovascular interventional therapy,so as to provide a basis for reducing the incidence of complications of rupture and bleeding during the coiling operation.Methods:The clinical and imaging data of patients with tiny intracranial saccular aneurysms who underwent endovascular neurointerventional treatment from January 2006 to May 2018 were retrospectively collected.Embolization treatment with endovascular interventional technique.Collect factors related to aneurysm:irregular aneurysm,whether the aneurysm is a wide-necked or narrow-necked aneurysm,aneurysm neck width,aneurysm volume,multiple aneurysms,aneurysm location.Collect patient-related factors:including age,gender,previous history of diabetes,hypertension,symptomatic stroke,drinking history,smoking history,and cardiovascular history.Collecting factors related to the surgical operation include:different treatment options(such as single microcatheter embolization,stent assisted embolization,microcatheter assisted embolization,balloon assisted embolization,microwire assisted embolization,multi-microcatheter embolization technology).Univariate analysis and multivariate analysis of its clinic and imaging characteristics were used to study the risk factors of complications of tiny intracranial saccular aneurysms rupture and bleeding during endovascular interventional treatment.Results:In 459 cases of tiny intracranial aneurysms,8 cases(1.7%)had complications of nervous system hemorrhage.There were 8 patients with intraoperative rupture and bleeding complications,and 451 patients without rupture and bleeding complications.The average age of rupture group was 49.00 ± 14.47 years old,the average age of unruptured group was 56.11 ± 10.14 years old.Univariate analysis results:history of hypertension(P=0.031),ruptured aneurysm(P=0.008),aneurysms located in anterior cerebral artery system(P=0.012),irregular shape(P=0.001),aneurysm volume(P=0.057),anterior communicating artery aneurysm(P=0.006),stent assisted embolization(P=0.017),aneurysm volume(P=0.057),stent assisted embolization(P=0.007)The number of coils used in a single aneurysm(P=0.098)was associated with intraoprocedure rupture of tiny intracranial aneurysms.The number and length of coils in ruptured group and unruptured group were compared.The average number of coils in ruptured group was 2.50±0.71,while in unruptured group 1.79±0.74,the difference was statistically significant(P=0.037).The average coil length of the rupture group was 5.69±0.87 cm,higher than in unruptured group 5.10 cm±0.83cm,the difference was not statistically significant(P=0.17).Multivariate analysis results:irregular shape(P=0.001,OR=7.248),ruptured aneurysm(P=0.001,OR=5.738),anterior cerebral artery system(P=0.047,OR=2.806),stent assisted embolization(P=0.039,OR=3.490)were the independent risk factors of intraoperative aneurysm rupture bleeding complications.ROC curve was used to analyze the above independent risk factors,and the AUC of stent assisted embolization was the largest(0.760),which had higher predictive value.The AUC of four independent risk factors(irregular shape,ruptured aneurysm,anterior cerebral artery system,stent assisted embolization)was 0.868,which was the best predictor.Conclusion:Irregular shape,ruptured aneurysm,anterior cerebral arterial system,and stent-assisted embolization are independent risk factors for intra-operative aneurysm with bleeding complications during the treatment of tiny intracranial saccular aneurysms.Stent assisted embolization has higher predictive value,while irregular shape,ruptured aneurysm,anterior cerebral artery system and stent assisted embolization combined are the best predictors.Part Ⅲ Analysis of risk factors for ischemic complications of tiny intracranial saccular aneurysms after endovascular neurointerventional therapyObjective:Analyze the risk factors of thromboembolic complications in tiny intracranial saccular aneurysms in endovascular interventional treatment,and provide reference for reducing the incidence of ischemic complications.Methods:The clinical data of patients with tiny intracranial saccular aneurysms who underwent endovascular interventional therapy from January 2006 to May 2018 were retrospectively collected.Analyze its clinical and imaging characteristics.The clinical and imaging characteristics were analyzed by Univariate analysis and multivariate analysis,and the possible risk factors of thromboembolic ischemic complications were analyzed.Results:A total of 31 cases(6.8%)of 459 cases of tiny intracranial saccular aneurysms had complications of thromboembolic ischemia.There were 31 cases in the intraoperative ischemic complications group and 428 cases without ischemic complications group.The mean age of the ischemic complications group was 53.65±10.26 years,and the average age of the non-ischemic complications group was 56.11±10.14 years.The results of the univariate analysis indicated that:history of hypertension(P=0.015),ruptured aneurysm(P=0.002),irregular shape(P=0.008)were related to ischemic complications.Multivariate results showed that:history of hypertension(P=0.025,OR=2.625),ruptured aneurysm(P=0.003,OR=4.502),irregular shape(P=0.017,OR=3.086)are independent risk factors for ischemic complications in endovascular interventional treatment.The AUC of ruptured aneurysms was the largest(0.764),which had higher predictive value.ROC curve was used to analyze the above independent risk factors.The AUC of three independent risk factors(history of hypertension,ruptured aneurysm and irregular shape)was 0.842,which was the best predictor.Conclusion:The history of hypertension,ruptured aneurysm,and irregular shape are independent risk factors for ischemic complications related with treatment of tiny intracranial saccular aneurysm.Ruptured aneurysms have higher predictive value,and the combination of these independent risk factors is the best predictor.Part Ⅳ Analysis of risk factors for the recurrence of tiny intracranial saccular aneurysms following endovascular neurointerventional treatmentObjective:To analyze the postoperative clinical and imaging follow-up results of tiny intracranial saccular aneurysm after endovascular interventional therapy to study the risk factors for postoperative recurrence of tiny intracranial saccular aneurysms,and to reduce the recurrence of tiny intracranial saccular aneurysm.Methods:The clinical data of patients with tiny intracranial saccular aneurysm who underwent endovascular interventional therapy from January 2006 to May 2018 were retrospectively collected.Analyze its clinical and imaging characteristics.Use Univariate analysis and multivariate analysis to analyze its clinical and imaging characteristics,and analyze risk factors for recurrence.According to the time of recurrence,the rank sum test of two independent samples was carried out to explore the influence of risk factors on the recurrence time.Results:A total of 15 cases(3.3%)of 459 cases of tiny intracranial saccular aneurysm recurred during follow-up.There were 15 aneurysms in the recurrence group and 444 aneurysms in the non-recurrence group.The average age of the relapse group was 55.98±10.49 years,and the average age of the non-relapse group was 56.01±10.26 years.The results of univariate analysis showed:smoking(P=0.041),drinking(P=0.037),aneurysm located in the anterior cerebral artery system(P=0.047),ruptured aneurysm(P<0.001),irregular aneurysm(P<0.001),single microcatheter embolization(P=0.047),and Raymond Ⅲ level of embolization satisfaction(P<0.001)are related to the recurrence of tiny intracranial saccular aneurysm after endovascular neurointervention.Multivariate analysis showed Multiple aneurysms(P=0.019,OR=2.935),irregular shape(P=0.002,OR=7.931),ruptured aneurysm(P=0.007,OR=5.851),Raymond Ⅲ degree of embolization satisfaction(P=0.006),OR=6.032)are independent risk factors for recurrence of tiny intracranial saccular aneurysm.ROC curve was used to analyze the above independent risk factors.The AUC of aneurysm with irregular shape was the largest(0.768),which had higher predictive value.The combined prediction AUC of the above four risk factors(multiple aneurysms,irregular shape,ruptured aneurysms and Raymond Ⅲ grade of embolization satisfaction)was 0.887,which was the best predictor.The results of rank sum test of two independent samples showed that the recurrence time of Raymond grade Ⅲ aneurysms was shorter than that of Raymond grade Ⅰ+Ⅱ aneurysms(P=0.04).Conclusion:Multiple aneurysms,irregular shapes,ruptured aneurysms,and embolization satisfaction Raymond Ⅲ are independent risk factors for recurrence of tiny intracranial saccular aneurysm after endovascular neurointerventional treatment.The irregular shape of aneurysm has higher predictive value,and the combination of the above independent risk factors is the best predictor.The possibility of recurrence of Raymond Ⅲaneurysms in a short time after immediate embolization is high.