The Analysis For Influencing Factors In Prognosis And Recurrence After Endovascular Treatment Of Intracranial Ruptured Aneurysms

Objective:To investigate the general information,morphological characteristics,intraoperative and postoperative conditions of intracranial ruptured aneurysms by endovascular treatment with statistical methods and to explore various factors that affect the prognosis and recurrence of patients with intracranial ruptured aneurysms.This will provide a theoretical basis for clinicians to improve the treatment effect and the prognosis of patients,to reduce the recurrence rate of aneurysms.Methods :119 patients were retrospectively analyzed with intracranial ruptured aneurysm and endovascular treatment who were admitted to our department from December 2015 to September 2017.Factors that may affect the prognosis and recurrence of patients such as gender,age,history of hypertension,history of diabetes,Hunt-hess grading,CT Fisher classification,timing of surgery,operation methods,aneurysm size,location,neoplasia,embolization degree,intraoperative and postoperative complications as independent variables;The prognosis and aneurysm recurrence as dependent variables,the recovery of neurological function of the patient discharged after three months as a prognostic criteria;the reoccurrence of ruptured aneurysm in patients with rebleeding or imaging follow-up finding aneurysm recanalization as a measure of recurrence.The above independent variables firstly useone-way analysis of the chi-square test.The meaningful indicators use the multi-factor Binary Logistic regression analysis to screen out the independent risk factors affecting the prognosis and recurrence of patients.Results :There were 52 males and 67 females in 119 patients.The mean age was55.88 ± 11.561 years.Preoperative Hunt-hess grade I in 17 cases,grade II in 58 cases,grade III in 27 cases;CT Fisher graded Level 2 in 69 cases,Level 3 in 33 cases,and Level 4 in 18 cases;anterior circulation aneurysm in 109 cases,posterior circulation diameter less than 5mm in 10 cases;5-15 mm in 60 cases,medium-sized aneurysm in57 cases,more than 15 mm in 2 cases;wide-necked aneurysm in 49 cases and narrow-necked aneurysm in 70 cases,early surgery in 73 cases,delayed surgery in 39 cases and late surgery in 7 cases.Coil embolization in 84 cases,only stent implantation in 9 cases,Stent-assisted coiling in 26 cases;intraoperative vasospasm in 37 cases,thrombosis in 2 cases,aneurysm rupture in 3 cases,postoperative cerebral infarction in12 cases,hydrocephalus in 10 cases;There were 74 patients with complete embolization,34 patients with residual neoplasm and 11 patients with partial embolization.There were 84 patients with good prognosis,31 patients with poor prognosis,4 patients died accounting for 71%,26% and 3% of the total respectively.The 98 patients were followed up for 3 to 18 months by iconography,seventy cases were stable,11 cases were improved,17 cases were relapsed and the recurrence rate is 17%.The result of single factor analysis showed that history of hypertension,history of diabetes,Hunt-hess grading,CT Fisher classification,timing of surgery,intraoperative embolization,postoperative complications are related to the prognosis(P<0.05);aneurysm size,surgical method and degree of embolism in the patients are related to the aneurysmal recurrence(P<0.05).The binary logistic regression analysis showed that preoperative Hunt-hess grade(P<0.05,OR=4.937),Fisher CT(P<0.05,OR=12.637)classification,postoperative complications(P< 0.05,OR=128.582)are the significantly relevant risk factor for prognosis.The only stent placement(P=0.004,OR=9.564),non-stent embolization(P=0.021,OR=0.595),large aneurysm(P=0.036,OR=0.181),Raymond III(P=0.007,OR=7.985)are independentrisk factors of recurrence after embolization.Conclusions:1.The factors influence the prognosis of patients with ruptured aneurysm included hypertension,diabetes,Hunt-hess grade,CT Fisher grade,the timing of surgery,embolism,intraoperative and postoperative complications,of which Hunt-hessIII and IV,CT Fisher4,postoperative complications are the significantly relevant risk factors affecting the patient's prognosis.2.The aneurysm size,surgical approach and embolism degree influence the recurrence rate of the patients.In addition,only stent placement,non-stent embolization,large aneurysm,Raymond II and Raymond III are independent risk factors of recurrence after embolization.3.Perioperative Controling of blood pressure,blood sugar,and striveing for early surgery,reducing intraoperative and postoperative complications,packing aneurysm as completely as possible,large aneurysms using stent-assisted embolization,which is the key to reduce the aneurysmal recurrence and improve prognosis.