| BackgroundThe intracranial aneurysm is a weakness in the wall of an artery that causes bulging or out pouching of the wall. It is the first etiological cause of subarachnoid hemorrhage(SAH). With the continuous development of interventional material and technology, endovascular treatment has become the preferred treatment of intracranial aneurysms disease. And the occurrences and case fatality rates of early complications in the patients with the interventional therapy are much lower than those with craniotomy. In spite of the widely use of the GDC in interventional therapy, there are still risks of rupture during the operation which is implemented in the vessels that exist lesions.Some reports showed that the rate of the rupture in the surgery is 1.9％～16％, and 50％of the rupture were dead. However, there are small amounts of researches about the risk factors and emergency measure to the rupture of intracranial aneurysm during the operation. Based on the above issues, we analyzed retrospectively the patients which are diagnosed with intracranial aneurysms that are treated with endovascular therapy in Shang dong University Qilu Hospital in recent 4 years. which can also provide evidence and guidance for future treatment.ObjectiveTo identify the risk factor to the rupture of intracranial aneurysms during the endovascular embolizations, and provide the foundation for the prediction and clinical management of the rupture of intracranial aneurysms during the endovascular embolizations.MethodsA retrospective analysis was performed on 549 patients admitted to Qilu Hospital between September 2011 and September 2015, who were diagnosed as ruptured intracranial aneurysms by DSA and were treated by endovascular embolizations. And 9 patients of them were dead. The following characteristics were recorded and univariate and multivariate statistically analyzed:sex, age, the number of hemorrhage previous, initial symptom, hypertension history, history of coronary heart disease, the time between hospitalized and therapy, simultaneous DSA and therapy, the operation room, the surgeon, the number of aneurysm, the size of aneurysm neck, the size of aneurysm, juncture of therapies(time cell between first SAH and first interventional therapy), the location of aneurysm, the existence of pseudoaneurysm or not, cerebral vasospasm during the operation, Hunt-Hess grade, the morphology of aneurysm, the variety of compounding technology.Then analyze the risk factors of the rupture of intracranial aneurysms during endovascular embolizations and summarizethe treatment measures and the prognosis of the 21 patients with rupture during endovascular embolizations.ResultsIn the 549 patients in our analysis,21 aneurysms (3.8%) were ruptured during the operation, with 9 cases of death. Our analysis revealed that there was no significant difference in sex (x2=0.487,P=0.491>0.05),age (x2=8.709,P=0.121> 0.05), the number of hemorrhage previous (x2=2.092, P=0.404>0.05), initial symptom (x2=2.793, P=0.247>0.05), hypertension history (x2=0.111,P=0.739> 0.05), history of coronary heart disease (x2=2.098, P=0.142>0.05), the time between hospitalized and therapy (x2=8.402, P=0.154>0.05), simultaneous DSA and therapy (x2=0.150, P=0.698>0.05), the operation room (x2=0.363, P=0.572>0.05), the surgeon (x2=2.819, P=0.665>0.05), the number of aneurysm (x2=0.614, P=0.413 >0.05), the size of aneurysm neck (x2=1.310, P=0.494>0.05), the size of aneurysm (x2=3.691, P=0.418>0.05), the morphology of aneurysm (x2=19.594, P=0.318>0.05),juncture of therapies (x2=3.897, P=0.257>0.05), the location of aneurysm (x2=6.080, P=0.445>0.05), the existence of pseudoaneurysm or not (x2=0.364, P=0.4>0.05). While the significance difference could be seen in cerebral vasospasm during the operation (x2=16.665, P=0.002<0.05), Hunt-Hess grade (x2=13.415, P=0.01<0.05), the variety of compounding technology (x2=17.476, P=0.028<0.05) between the two groups. Multiple-factor analysis revealed that cerebral vasospasm during the operation (OR=6.093, P=0.02), Hunt-Hess grade (OR=8.622, P=0.03) were independent risk factors. We had not found the obvious relationship between the prognosis of these patients with ruptured aneurysm during the operation and break up time (P=0.109>0.05), the solution after the rupture (P=0.266>0.05) and the hydrocephaly needed operation (P=0.069 >0.05)ConclusionOur analysis demonstrated that the independent risk factors to the rupture of intracranial aneurysms during endovascular embolizations were obvious intracranial vascular spasms during the operation, Hunt-Hess grade. We should be more vigilant in aneurysm patients with risk factors to prevent the rupture during the operation in our daily clinical work. Once the aneurysm ruptures during the operation, doctors must take measures immediately, then almost half of these patients can have a good recover. |
PDF Full Text Request