Risk Factors Of Intraprocedural Rerupture In The Embolization Of Ruptured Intracranial Aneurysms

Background: Intracranial aneurysms are hemangioma-like expansions caused by local abnormal changes in cerebral blood vessels.The death rate of subarachnoid hemorrhage caused by rupture of intracranial aneurysms is as high as 30%-45%,and most of the survivors remain severe neurological dysfunction.In recent years,with the rapid development of intravascular interventional treatment technology,intravascular embolization of aneurysms has gradually become one of the main clinical methods for treating intracranial aneurysms.Intracranial arterial re-rupture is the most dangerous complication of aneurysm embolization,which can easily lead to surgical failure or even death if it is not handled properly,and it has a serious impacts on the patients' prognosis.Although the re-rupture event during intracranial rupture aneurysm is a topic that every neurosurgeon cannot avoid,the reports on systematic analysis of its risk factors and emergency treatment measures are still relatively scarce.Objective: To investigate the risk and possible causes of re-rupture events during intravascular interventional therapy in patients with ruptured subarachnoid hemorrhage of intracranial aneurysm.To find effective measures to reduce the incidence of intraprocedural re-rupture,and to improve clinical outcomes.Methods: Retrospective analysis of patients with intracranial ruptured aneurysm undergoing endovascular interventional treatment from June 2017 to September 2019,and collected clinical data including hospitalization records,surgery records,imaging data,postoperative follow-up and other clinical data of the included patients.The collected data includes: basic information of the patient(age,gender,history of hypertension,history of diabetes,history of coronary heart disease,smoking history),basic status of the patient before surgery(preoperative Hunt-Hess classification,and whether there are symptomatic cerebrovascular diseases before surgery,vascular factors(aneurysm size,aneurysm location,neck width,aneurysm shape regularity,AR value,SR value,whether cerebral vasospasm occurs during operation),treatment factors(treatment method,timing of treatment,aneurysm Degree of embolism).The experimental data was statistically analyzed using SPSS 19.0 software.All the collected clinical data were analyzed by single factor analysis and multi-factor logistic regression analysis to determine the risk factors of intraoperative re-rupture events.Results: A total of 325 cases of aneurysmal subarachnoid hemorrhage who underwent endovascular interventional embolization were included,of which 13 were re-ruptures during embolization,and the incidence of intraprocedural re-rupture was4%.Single factor analysis showed that there are significant differences between history of hypertension(P = 0.02),aneurysm size(P = 0.037),aneurysm morphology(P =0.02),intraoperative cerebral vasospasm(P = 0.027)and AR value of aneurysm(P =0.03).However,the patients' age,gender,history of diabetes,history of coronary heart disease,smoking history,Hunt-Hess classification before surgery,presence of symptomatic cerebral vasospasm,location of aneurysm,neck width,SR value,whether cerebral vasospasm occurred during the operation,The treatment method,timing,and degree of aneurysm embolization had no significant relationship with the aneurysm rupture event during operation(P> 0.05).Further multivariate analysis showed that aneurysm size,AR value,history of hypertension,and intraoperative cerebral vasospasm were risk factors for intraoperative re-rupture events.Conclusions: 1.history of hypertension exacerbates changes in cerebrovascular atherosclerosis,leading to difficult intraoperative blood pressure management and fluctuations in blood pressure,and is a risk factor for re-rupture events during aneurysm embolization.2.Tiny aneurysms(<5mm)and fusiform or irregular aneurysms with high aspect ratios increase the risk of re-rupture events during embolization.3.Patients with aneurysms who experience vasospasm during embolization have a significantly higher risk of rupture.