Analysis Of Prognosis And Risk Factors Of 730 Patients With Anterior Communicating Aneurysm

Objective:Anterior communication artery aneurysms(ACoAA)is one of the most common intracranial aneurysms,accounting for about 20%.The mortality rate of aneurysm rupture is 40%for the first time and 80%for the second time.The primary therapeutic goal for anterior communicating aneurysms is to occluded aneurysms to prevent rerupture and hemorrhage.However,the prognosis of patients with either clipping operation or interventional embolization is quite different.However,due to the changeable condition and complicated anatomical characteristics of anterior communicating aneurysm,there are many confounding factors affecting the treatment prognosis,so it is difficult to evaluate the strength of association between anterior communicating aneurysm and prognosis.In this study,clinical data of 730 patients with anterior communicating aneurysm treated by clipping or embolization in the Department of Neurosurgery in the First Affiliated Hospital of Soochow University were collected and analyzed retrospectively.The study focused on the prognosis of anterior communicating aneurysm patients treated by clipping surgery or interventional embolization and analyzed the risk factors affecting the prognosis.METHODS:Clinical data of 730 patients with anterior communicating aneurysms admitted to the Department of Neurosurgery in the First Affiliated Hospital of Soochow University from January 1,1999 to December 31,2018,who met the inclusion criteria,were collected.Data processing was carried out on SPSS25.0 statistical analysis software.The groups were divided into two operation groups from 1999 to 2008 and from 2009 to 2018,operation group and intervention group from 2009 to 2018.First,the differences in clinical data between the two groups were compared.The qualitative data were tested by chi-square test or Fisher's exact test,and the quantitative and grade data were tested by independent sample t or rank-sum test to analyze the difference in prognosis between the two groups and the difference in prognosis between the operation group and the interventional group from 2009 to 2018.Then,according to the GOS score,730 patients with anterior communicating aneurysm were divided into the group with good prognosis and the group with poor prognosis.Univariate Logistic regression was carried out to analyze the related risk factors affecting the prognosis of the patients.Finally,relevant risk factors were included in multivariate Logistic regression to analyze the independent risk factors affecting the prognosis of the patients,and P<0.05 indicated that the difference was statistically significant.Results:The rate of poor prognosis was 32.7%in the operation group from 1999 to 2008,and 21.3%in the operation group from 2009 to 2018,and the rate of intraoperative aneurysm rupture and postoperative cerebral infarction was lower in the operation group from 2009 to 2018(P<0.05).There was no significant statistical difference in the prognosis between the operation group and the interventional group from 2009 to 2018(P?0.05).There were no statistically significant differences in the influence of age,gender,hypertension and aneurysm morphology on the prognosis of the patients(P>0.05).Preoperative hunt-hess classification,Fisher classification,treatment period,aneurysm size,aneurysm direction,intraoperative rupture,postoperative cerebral vasospasm,postoperative cerebral infarction,postoperative hydrocephalus and postoperative cerebral hemorrhage had statistically different effects on the prognosis of patients(P<0.05).Results of multivariate regression analysis,preoperative hunt-hess grade,postoperative cerebral infarction and postoperative cerebral hemorrhage had significant differences among different prognosis groups(P<0.05).Conclusion:The prognosis of anterior communicating aneurysm patients treated with clipping surgery from 2009 to 2018 was significantly better than that from 1999 to 2008.There was no significant difference in prognosis between the clipping surgery group and the interventional embolization group from 2009 to 2018.Preoperative hunt-hess grade,Fisher grade,treatment period,aneurysm size,aneurysm direction,intraoperative rupture,postoperative cerebral vasospasm,postoperative cerebral infarction,postoperative hydrocephalus and postoperative cerebral hemorrhage are all risk factors affecting the prognosis of patients.Preoperative hunt-hess grade,postoperative cerebral infarction and postoperative cerebral hemorrhage are independent risk factors affecting the prognosis of anterior communicating aneurysm patients.