Complications And Follow-up Study Of Stent-assisted Coiling Of Cerebral Aneurysms

BACKGROUNDIntracranial aneurysms(IAs)may be lesions that cause localized expansion of the cerebral arterial wall by both genetic and environmental factors.It has been reported in the literature that the incidence of intracranial aneurysms is 3.6%-6%5 and the rupture rate is 1%-2%.The mortality rate and the disability rate account for 22%to 25%of the patients with cerebrovascular disease respectively,and show a gradually increasing trend.Intracranial aneurysm rupture is the main cause of spontaneous subarachnoid hemorrhage(SAH).The mortality of the first hemorrhage caused by rupture of the aneurysm is about 15%-20%,and the mortality rate within 2 years without timely diagnosis and treatment can reach 75%-85%.With the accumulation of experience and advances in technology,stent-assisted coiling(SAC)is an effective way to treat cerebral aneurysms.SAC provides high rates of complete occlusion and low rates of recurrence,maintaining its role as the mainstay of treatment of wide-necked intracranial aneurysms.However,previous studies have reported that patients undergoing SAC had significantly higher rates of morbidity and mortality,compared with patients undergoing coiling alone.During the treatment of intracranial aneurysms,it is a key problem for clinicians to clarify the relationship between perioperative complications and related risk factors,and how to timely and effectively prevent and deal with complications.Meanwhile,intracranial aneurysms are classified into unruptured aneurysms and ruptured aneurysms.Compared with unruptured aneurysms,the incidence of complications and mortality of patients with ruptured aneurysm are significantly higher.The safety and efficacy of different types of stent-assisted coiling for the treatment of ruptured aneurysms are controversial.Therefore,we conducted a retrospective study on the cases of different types of stent-assisted coiling for intracranial aneurysms,so as to evaluate the complications and follow-up results of different types of stents for aneurysms with different locations,shapes and sizes,and provide theoretical basis for the treatment of intracranial aneurysms with endovascular embolization.Parti Analysis of risk factors for perioperative complications ofstent-assisted coiling of cerebral aneurysmsOBJECTIVE:To explore the risk factors of perioperative complications of stent-assisted coiling for cerebral aneurysms.METHODS:A retrospective analysis of 395 patients with stent-assisted coiling of cerebral aneurysms from 1 January 2011 to 31 December 2017 in Zhujiang Hospital was performed.Clinical data were collected.Univariate and multivariate logistic regression determined the statistical significance of the risk factors.The preoperative aneurysm status was analyzed by Hunt-Hess grade and trend test was conducted to analyze its statistical significance.RESULT:Intraprocedural thrombosis and hemorrhage occurred in 2.28%(9/395)and 1.01%(4/395),respectively.Postprocedural ischemic stroke and hemorrhage occurred in 3.54%(14/395)and 1.27%(5/395),respectively.One patient suffered intraprocedural thrombosis and postprocedural ischemic stroke.Univariate logistic regression analysis showed that pretreatment ruptured aneurysm were related factors for perioperative complications(ORF=2.466,95%CI:1.267?4.797,P=0.008).In multivariate logistic regression analysis,diabetes and pretreatment ruptured aneurysm were independent predictors for complications(OR=4.275,95%CI:1.260?14.508,P=0.020;OR=2.442,95%CI:1.182?5.043,P=0.016).Compared with low Hunt-Hess grade,higher Hunt-Hess grade was associated with higher risk for complications in tests for linear trend(OR=1.509,95%CI:1.142?1.993,P=0.004).CONCLUSION:The incidence of perioperative complications was higher in patients with diabetes or pretreatment ruptured aneurysm.The increased Hunt-Hess grade was significantly associated with the increased incidence of complications.Part2 Clinical analysis of stent-assisted coiling of ruptured cerebral aneurysmsOBJECTIVE:To explore the efficacy and safety of stent-assisted coiling of ruptured cerebral aneurysms.METHODS:A retrospective analysis of 230 patients with stent-assisted coiling of cerebral aneurysms was performed at Department of Neurosurgery,Zhujiang Hospital,Southern Medical University from 1 January 2011 to 31 December 2017.The date of termination for observation was June 30,2018.All patients underwent stent-assisted coiling.The data of intraoperative and postoperative complications was collected.And the clinical prognosis was further evaluated by modified Rankin Scale(mRS).RESULT:Data for 230 patients undergoing stent-assisted coiling of their aneurysm were enrolled in the statistics.Thromboembolic and hemorrhagic events occurred in 7.2%(12/166)and o(0/166)among patients with unruptured aneurysms.Thromboembolic and hemorrhagic events occurred in 7.8%(5/64)and 4.7%(3/64)among patients with ruptUred aneurysms.16.3%(27/166)patients with unruptured aneurysms experienced recurrence while 26.6%(17/64)patients with ruptured aneiurysms did.However,there was no significant difference in complication rate and rate of aneurysm recurrence between patients with unruptured aneurysms and those with ruptured aneurysms(P>0.05).Analyzing the repeated measures data by the generalized estimating equation,a marked reduction in mRS score at the final(compared with Pretreatment mRS score)follow-up was apparent in patients with ruptured aneurysms,even after controlling for demographics and comorbidities(P<0.001).However,non-significant difference was observed in patients with unruptured aneurysms(compared with Pretreatment mRS score)(P>0.5).CONCLUSION:Stent-assisted coiling is a safe and effective treatment of ruptured intracranial aneurysms.