Factors Influencing The Prognosis Of Patients With Multiple Intracranial Aneurysms And It’s Therapeutic Strategies

Objective:1.To analyse the clinical characteristic of MIA.2. To explore the factors that influence the prognosis of patients with MIA.3. To explore the treatment strategy of MIA, according to the analysize result and the experience of our department.Methods:A retrospective review was performed to analyze the clinical data of80patents who had been managed in our department from January2009to January2013for MIA,including the patients’ general information, clinical features, imaging findings, therapeutic methods and effects,following-up data. Of73patients undergoing microsurgical operation or endovascular treatment in our center,31cases were treated by microsurgical operation,the endovascular treatment was performed in33cases, and the rest received the combined therapy with the two methods,55cases were treated by one-stage and18by stages, the aneurysms in43patients were all managed, the unresponsible aneurysms still existed in30patients,7patients only underwent the conservative treatment because of the age, poor performance and home condition. All of the80patients were followed, the time ranged from3months to3years. The prognosis was presented by the Glasgow outcome scale(GOS) of the patients after leaving the hospital3months,5and4points were divided into good prognosis, and below3points for poor. Then the relationship of prognosis with the age and gender of the patients, whether having the risk of high blood pressure, the hospitalized Hunt-Hess grade, the CT-fisher grade, and the size, quantity, distribution of the aneurysms, methods and timing of the treatment, whether staging was performed by the mutiple factors analysis using the unconditioned binary classification Logistic regression.Then according to the single factor analysis,the prognosis of patients with different treatment methods and timing can be found.Results:1.The male to female ratio was1:2.5, the average age was55.0yeas old, previous history of hypertension accounted for60%,of the female menopause accounted for63.2%of all female patients, a history of smoking took22.5%, and a history of drinking took18.8%in the80cases with MIA. In all of the aneurysms small saccular aneurysm (diameter<5mm) accounted for about83.6%,the ones located in the anterior circulation accounted for85%, the ones who were the bilateral and symmetrical distribution of the so-called mirror aneurysm accounted for23.8%.2.According to Glasgow outcome scale,53patients got5points,2cases got4points, and23patients for3points,2for1point. The single factor analysis showed that the hospitalized Hunt-Hess grade, CT-fisher grade, treatment protocol and timing had significant influences on the prognosis of the patients (P<0.05); the multiple regression analysis revealed that the hospitalized Hunt-Hess grade, treatment protocol and timing were independent risk factors of the prognosis of the patients (P<0.05).3.The single analysis also showed that the prognosis of patients in endovascular treatment group compared with the combined group,surgicle clipping group and the conservative treatment group was statistically significant (P<0.05), the prognosis the3weeks after attacking and in3weeks treatment group was statistically significant (P<0.05).Conclusions:1.In the patients of MIA, the numble of women was more than the men,the age was more commen in40-65years old.The pathogen was ralated to the previous history of hypertension, menopause,smoking and drinking. In the MIA, the small sized saccular anurysms were more commen, most were located in the anterior circulation and the bilateral symmetrical ones distributed about a quarter.2.MIA short-term prognosis of patients by the patients on admission neurological status, influence treatment. Endovascular treatment group short-term prognosis than the combined treatment group, the surgical treatment group and the conservative treatment group. Long-term prognosis only affected by the admission neurological status more obvious.3.Individualized treatment strategies were classified according to the distribution of MIA. Principle was to first deal with the responsible aneurysm, non-responsible aneurysms treated by one time; cystic narrow neck MIA preferred embolization; emergency application was not recommended bracket; Bilateral carotid artery or vertebral artery should not be stented at the same time. Level one:narrow neck should be dealed by embolization, if there was a wide-necked aneurysm, aneurysm neck can be easily exposed separation, surgical clipping can be used. Level two:if the responsibility aneurysm was difficult to determine, all MIA should be dealed with preferred embolization. Responsibility aneurysm clear narrow neck preferred embolization combined non-responsibility aneurysm narrow neck over the same period embolism, stent-assisted embolization or surgical clipping of wide-necked installments; responsibility for wide-necked aneurysm was a viable part of the embolism, two stent-assisted dense embolism, can also be a surgical clipping, the combined non-responsibility aneurysm narrow neck an embolism, stent-assisted embolization or surgical clipping of wide-necked installments line, can not be bilateral carotid artery stent for the same period auxiliary embolism. Level three: preferred embolization, stent-assisted embolization can not bilateral vertebral artery same period. Level four:posterior circulation aneurysms prefered embolization, aneurysms process with reference to a two first deal with the responsible aneurysm, non-responsible aneurysm as a total processing.