Analysis Of Risk Factors Of Early Rebleeding Of Ruptured Intracranial Aneurysms After Endovascular Embolizations

Objective: To retrospectively analyze the clinical and imageological characteristics of patients with early rebleeding of ruptured intracranial aneurysms after endovascular embolizations, and to approach the risk factors and mechanisms correlated to the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations and the measures of reducing the incidence of the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations, to provide the helpness for the clinical therapies.Methods: Retrospectively analyze the data of patients admitted to Changhai hospital between Jul 2002 and Oct 2007, who were definited ruptured intracranial aneurysms by DSA and were treated by endovascular interventional embolotherapy, make the patients of ruptured intracranial aneurysms with rebleeding after interventional therapy in three months as the case group, and statistics the incidence and the mortality of the early rebleeding after endovascular embolizations, Analyze the clinical and imageological characteristics of the case group, and randomly draw 7.5 times of the case group as the contral group from the patients without rebleeding embolized at the same time. The following characteristics were recorded and univariate and multivariate statistically analyzed:age, sex, history of hypertensive disease, location and size of the aneurysms, wide-neck or not, regular shape or not, real or false aneurysms, bubble on the neck of aneurysms or not, number of times of ruptures of aneurysms before endovascular embolizations, juncture of therapies(time cell between first SAH and first interventional therapy), clinical condition of the patient in the first interventional therapy(Hunt-Hess grade), intracranial adjacent hemotoma near the ruptured aneurysm on admission CT, obvious intracranial vascular spasms by DSA when coiling, the style of interventional therapy, level of endovascular embolizations of the aneurysms, anticoagulant therapy or not after treatment, obviouse fluctuation of blood pressure after treatment or not, electrolytic disorder after treatment or not, time of rebleeding after endovascular embolizations(time cell between first interventional therapy and rebleeding ), clinical outcome(GOS grade), DSA or interventianl or trapping therapy after rebleeding or not et al. Gain the risk factors correlated to the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations and approach the mechanisms and the effective measures of reducing the incidence of the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations.Results: 1. Retrospectively analyze the data of 1298 patients suffered SAH and admitted to Changhai hospital between Jul 2002 and Oct 2007, remove the patients with the negative result of DSA and not treating with interventional therapy, then gain the data of 881 patients who were definited ruptured intracranial aneurysms by DSA and were treated by endovascular interventional embolotherapy. Screen out 17 patients of ruptured intracranial aneurysms with rebleeding after interventional therapy in three months(the incidence was 1.9%), 12 patients of them were dead(the mortality was 70.6%). 2,univariate statistical analysis between the case group and the randomly drawed contral group of 123 patients found that there were significant differences between the case group and the contral group in the last ten contents: wide-neck of aneurysems or not, real or false aneurysms, number of times of ruptures of aneurysms before endovascular embolizations, juncture of therapies (time cell between first SAH and first interventional therapy), intracranial adjacent hemotoma near the ruptured aneurysm on admission CT, obvious intracranial vascular spasms by DSA when coiling, the style of interventional therapy, level of endovascular embolizations of the aneurysms, anticoagulant therapy or not after treatment, obviouse fluctuation of blood pressure after treatment or not and electrolytic disorder after treatment or not, there were statistical significance (P < 0.05). there weren't significant differences between the case group and the contral group in the last seven contents: age, sex, history of hypertensive disease, location and size of the aneurysms, regular shape or not, clinical condition of the patient in the first interventional therapy(Hunt-Hess grade), there weren't statistical significance (P>0.05). 3,According to the results of the univariate statistical analysis and clinical practice, multivariate logistic regression analysis was underwent between the selective fourteen indexes, the result showed that real or false aneurysms, number of times of ruptures of aneurysms before endovascular embolizations, obvious intracranial vascular spasms by DSA when coiling and level of endovascular embolizations of the aneurysms were independent risk factors correlated to the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations, there was statistical significance (P < 0.05); although anticoagulant therapy or not after treatment was excluded, because there wasn't statistical significance (P=0.0648 >0.05), but it was introduced into the logistic regression equation. Being conbined with clinical experience, it was closely related to the early rebleeding. 4,With multivariate logistic stepwise regression analysis, five indexes of real or false aneurysms(X₁), number of times of ruptures of aneurysms before endovascular embolizations(X₂), obvious intracranial vascular spasms by DSA when coiling(X₃), level of endovascular embolizations of the aneurysms(X₄) and anticoagulant therapy or not after treatment(X₅) were introducted into the probability equation of the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations. Log(P)=-15.9451 + 10.8959X₁ + 3.9959X2 + 3.3805X₃ + 2.2772X₄ + 6.1642X₅, P was the probability of the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations, percent concordant=97.0%, percent discordant=2.2%.Conclusion: This study objectively demonstrated the clinical and imageological characteristics of patients with early rebleeding of ruptured intracranial aneurysms after endovascular embolizations, showed that the incidence of patients with early rebleeding of ruptured intracranial aneurysms after endovascular embolizations was very low, but the mortality was particularly high. The results of this study showed that the independent risk factors correlated to the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations were real or false aneurysms, number of times of ruptures of aneurysms before endovascular embolizations, obvious intracranial vascular spasms by DSA when coiling and level of endovascular embolizations of the aneurysms, and this study analyzed the mechanisms of the early rebleeding. The probability equation of the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations that aggregated from our study can be used into the clinical practice to guide treatment. It's benefit that embolizing aneurysms completely as far as possible in the surgery and early and timely DSA follow-up after endovascular embolizations to reduce the incidence of the early rebleeding of ruptured intracranial aneurysms after endovascular embolizations, positive retreatment can improve the prognosis of patients with rebleeding.