Analysis Of Clinical And Radiological Features Of Intracranial Ruptured Saccular Aneurysms Based On Single Center And Large Sample

Objective: Aneurysm subarachnoid hemorrhage(aSAH)is characterized by high morbidity,high mortality and high rate of disability.In this study,the clinical and imaging features of all ruptured saccular aneurysms in the department of neurosurgery in Changhai Hospital were analyzed.And we discussed the similarities and differences between our center and other similar domestic and abroad research results.Methods: The retrospective study included 1,945 patients with subarachnoid hemorrhage caused by ruptured intracranial saccular aneurysms in the Department of Neurosurgery,Changhai Hospital,from January 2001 to December 2017.All the patients underwent angiography with complete clinical and imaging data.The following factors were analyzed by statistical method: age,sex,admission Hunt-Hess scale,hypertension,diabetes,hyperlipidemia,coronary heart disease,cerebral artery stenosis,smoking history;whether associated with intraventricular hemorrhage;the size,location,shape of aneurysm;maximum diameter of aneurysm,aneurysm neck,whether wide neck aneurysm,whether multiple aneurysms;the characteristics of anterior and posterior circulation ruptured aneurysm,etc.Result: A total of 1945 patients with intracranial ruptured saccular aneurysms(859 males and 1086 females)were included.The ratio of male and female was 1: 1.26.The average age of the patients was 55.07±12.71 years;the average age of women was 56.83±12.60 years,and the average age of men was 52.83±12.52 years.There was a significant difference in the ratio of male and female aged over 60 or under 40,with a ratio of 1: 1.92 and 1: 0.77,respectively.960 cases accompanied with hypertension(49%);150 cases with diabetes mellitus(7.7%);96 cases with smoking history(4.6%);94 cases with hyperlipidemia(4.8%);208 cases with coronary heart disease(10.7%);169 cases with cerebrovascular atherosclerotic stenosis(8.7%).There were 307 cases of ruptured aneurysm accompanied with intraventricular hemorrhage,and the most cases were of anterior communicating artery aneurysm accompanied with intraventricular hemorrhage.There were 237 cases of anterior circulation complicated with hemorrhage and 70 cases of posterior circulation complicated with hemorrhage,which shows the chance of posterior circulation ruptured aneurysm with intraventricular hemorrhage was higher.The five most common sites of ruptured aneurysms are: the posterior communicating artery(26.17%),internal carotid artery(24.42%),anterior communicating artery(21.85%),middle cerebral artery(9.87%),and basilar artery(3.75%).The ratio of the right and the left was 1:1.82,and the anterior circulation aneurysm accounted for 88.79% of all ruptured aneurysms.Of the ruptured posterior circulatory aneurysms,the most common site of ruptured aneurysms is the basilar aneurysm(33.49%),followed by vertebral artery aneurysm and posterior cerebral artery aneurysm.The median of the maximum diameter of ruptured aneurysm was 4.8mm with the average of 5.93±4.26 mm.1051 cases of the size of aneurysm were less than 5mm;695 cases of aneurysm ranged from 5 to 10mm;and 89.77% of all aneurysms was less than or equal to 10 mm.The average of maximum diameter of ruptured basilar artery aneurysm was the largest with 8.24±6.67 mm.The average of the maximum diameter of ruptured anterior cerebral artery aneurysm was the lowest with 4.20±2.34 mm.The maximum diameter of posterior circulation aneurysm was significantly larger than that of anterior circulation aneurysm.There were 733 cases of wide neck carotid aneurysms in this group with the male and female ratio of 1: 1.08.The chance of wide neck carotid aneurysm was higher in male.A total of 1275 ruptured aneurysms with a dome to neck ratio less than1.5,and there was a significant difference in the ratio between male(62.51%)and female(67.96%).The maximum diameter of hypertensive patients with ruptured aneurysm was significantly higher than of the control group,and the maximum diameter of patients less than or equal to 40 years old was significantly smaller than of patients who were over 40 years old.518 patients harbored multiple aneurysms,accounted for 26.63% of the number of whole patients.Multiple aneurysms are more common in female patients,and the average age was obviously less than single aneurysm patients;multiple aneurysms had a higher incidence when aneurysm diameter was less than or equal to 10 mm.The incidence of hyperlipidemia and intraventricular hemorrhage after SAH in patients with posterior circulation aneurysm was significantly higher than that of patients with anterior circulatory aneurysm.The ratio,maximum diameter and SR value of wide neck carotid aneurysms were significantly higher than those of anterior circulatory aneurysm.Multivariate analysis showed that hyperlipidemia(OR=4.786)and Size Ratio(1.234)were independent risk factors for high grade aSAH.Conclusion: This single-center large sample study objectively reflects the clinical and imaging characteristics of patients with ruptured aneurysms in our hospital.The results of the study are basically consistent with the results of domestic and abroad similar large numbers cases,such as age,gender difference,Hunt-Hess grade,the condition of cerebral vasospasm,common location,size distribution of aneurysm,proportion of multiple aneurysms and shape of aneurysm.However,there are also some differences,such as the maximum diameter of aneurysms in hypertensive patients is significantly larger than that in non-hypertensive patients,which is contrary to the results reported abroad.The different results may be due to ethnic differences.In general,this study provides valuable information on the epidemiology and natural history of intracranial ruptured aneurysms in the population of China.