Clinical Analysis Of Stent-assisted Coils Embolization Of Acutely Ruptured Wide-necked Intracranial Aneurysms

Background:Intracranial aneurysms is a Cerebral angiomatous protrusions caused by localized dilation of intracranial artery wall,which is the main cause of spontaneous subarachnoid hemorrhage(SAH).The autopsy rate in the population ranged from 0.2%to 7.9%.Intracranial aneurysms mainly occurred in the population aged 40 to 60..and there was no difference between male and female.The incidence of first ruptured aneurysms was 1%to 2%.About 1/3 patients with ruptured aneurysms died before they went to the hospital,and survivors had a 20%risk of permanent neurological dysfunction.Rerupture of intracranial aneurysms is common within 24 hours after the first aneurysm rupture,with an incidence of 4.1%to 17.3%and a fatality rate of 31%to 62%.Therefore,early diagnosis and treatment can reduce the rerapture of aneurysm,reduce the mortality and disability rate,and improve the prognosis of the patients.The European International Subarachnoid Hemorrhage Trial(ISAT)demontrated that the endovascular treatment of ruptured aneurysms significantly reduced complications and mortality compared with surgical clipping.Endovascular embolization for ruptured intracranial aneurysms includes coiling alone embolization,single catheter technique for coil embolization,two-catheter technique for coil embolization,balloon assisted coil embolization and so on.Since the description by Higashida et al regarding stent placement to treat an acutely ruptured fusiform posterior fossa aneurysm in 1997 stent-assisted coil placement(SACP)has been increasingly used and extensively reported as an effective means to treat widenecked intracranial aneurysms,especially after the advent of self-expandable intracranial stents.However,there is no unified clinical guidelines for the treatment of ruptured intracranial aneurysms.Some studies have reported that stent-assisted coil embolization of ruptured intracranial aneurysms in the acute phase will increase the incidence of complications and mortality.And the complication rate was higher than that of balloon assisted coil embolization and simple spring coil.Other studies have reported that stent-assisted coil embolization for ruptured intracranial wide-necked aneurysms in the acute phase is safe and feasible.Owing to limitations in the number of reported cases and the varied inclusion criteria,the safety and effectiveness of SACP in acutely ruptured wide-necked intracrahial aneurysms are still unknown.Therefore,we retrospectively analyzed the clinical outcome,complications and follow-up of patients with intracranial ruptured wide-necked aneurysms treated by stent-assisted coil embolization at Department of Neurosurgery,Zhujiang Hospital,Southern Medical University in the past 7 years.The efficacy and safety of stent-assisted coil therapy were evaluated in patients with acutely ruptured wide-necked intracranial aneurysmsObjectiveTo analyze the risk factors of the operative complications,the clinical outcomes and the recurrence of the aneurysm during the perioperative period of the treatment of acutely ruptured wide-necked intracranial aneurysms by stent-assisted coil embolization.MethodsWe retrospectively analyzed the clinical outcomes and complications of 160 patients with acutely ruptured wide-necked intracranial aneurysms(160 ruptured aneurysms)who underwent stent-assisted coils embolization at Department of Neurosurgery,Zhujiang Hospital,Southern Medical University from January 2011 to May 2018.Procedizre--related complications included ischemic-related complications(intraoperative and postoperative intravascular thrombosis)and hemorrhagic-related complications(intraoperative and post-operative aneurysm ruptures).Modified Rankin score(mRS)was used to evaluate the pre-hospital clinical outcomes of the patients,which was divided into two groups:favorable clinical outcomes and unfavorable clinical outcomes.According to the follow-up images,the patients were divided into two groups:non-recurrence group and recurrent group.Univariate factor analysis and multiple logistic regression analysis were conducted aiming at age,sex,preoperative Hunt-Hess grade,pre-hospital mRS score,aneurysm size,aneurysm location,therapy time,embolization degree,stent type.ResultsIn 160 patients,the percentage of complete occlusion after endovascular procedures was 79.4%.Surgery-related complications occurred in 17(10.6%)cases,out of which 6(3.8%)showed hemorrhagic events and ischemic events was observed in 11 case(6.9%)*Univariate analysis indicated that the location of aneurysm(P=0.047)might the influencing factors of ischemic complications.Unfavorable clinical outcomes were reported in 24(15%)cases.Logistic regression analysis indicated that pre-hospital mRS score?4(OR,39.000,95%Cl:10.861?140.038,P<0.001),preoperative Hunt-Hess grade ?-?(OR,13.000,95%Cl:4.063?41.596,P=0.015),and Solitaire stents placement(OR,3.333,95%Cl:1.332?8.339,P=0.028)were the independent risk factors for the unfavorable clinical outcomes in patients with acutely ruptured wide-necked intracranial aneurysms.Imaging follow-up results were obtained in 113 patients(70.6%),and aneurysm recurrence occurred in 11 patients(9.7%),including 6 cases of residual neck and 5 cases of sac residual.Univariate analysis showed that the size of aneurysm and the degree of embolization had significant effect on the recurrence of aneurysm(all P<0.05);Logistic regression analysis showed that the size of aneurysm>10 mm,the sac residual was the risk factor for recurrence of aneurysm.ConclusionStent-assisted coils embolization is suggested to be a safe and efficacious way to treat acutely ruptured wide-necked intracranial aneurysms,and patients with pre-hospital mRS score?4,preoperative Hunt-Hess grade ?-? and Solitaire stents placement are more prone to poor clinical outcomes.Patients with aneurysm size>10mm and sac residual were prone to recurrent aneurysms.