Analysis Of Prognostic Factors In Patients With Ruptured Anterior Circulation Intracranial Aneurysms

Objective: Intracranial ruptured aneurysm(RIA)is the pathological expansion and rupture of the cerebral artery wall.RIA can lead to subarachnoid hemorrhage,which is a cerebrovascular disease with high disability rate and mortality.The anterior circulation is the internal carotid artery system that supplies blood to the frontal,temporal,parietal,and basal ganglia areas of the anterior 3/5 of the cerebral hemisphere.This study mainly focused on anterior circulatory RIA.After clipping or embolization,the relevant factors before,during and after operation were statistically analyzed to find out the risk factors affecting the poor prognosis of anterior circulatory RIA,so as to provide objective evidence for patients to obtain a good prognosis.Methods:Anterior circulation RIA confirmed by CTA,MRA or DSA examination and meeting inclusion and exclusion criteria were collected from the affiliated Zhong Da hospital of southeast university from September 2014 to September 2019.All patients were treated with aneurysms clipping or interventional embolization.The factors affecting the prognosis were analyzed by SPSS23.0 software for univariate and Logistic multivariate analysis.Results:Prognostic indicators were graded according to Glasgow outcomes scale.A total of 227 patients were followed up 6 months after surgery,including 10 patients of grade I,27 patients of grade II,40 patients of grade III,130 patients of grade IV,and20 patients of grade V.Grade I-III indicates poor prognosis,and grade IV-V indicates good prognosis.Six months after the treatment of intracranial aneurysms,the rates of good and bad prognosis were 66.1% and 33.9%,respectively.Single factor analysis showed that hypertension,diabetes,CT Fisher classification,Hunt-Hess classification,delayed cerebral ischemia,hydrocephalus,and pulmonary infection had statistical differences(P<0.05).According to logistic multivariate analysis,hypertension(OR=0.321,95%CI=0.156-0.660,P<0.05),diabetes(OR=0.250,95%CI =0.115-0.543,P<0.05),CT Fisher classification(OR=0.313,95%CI=0.147-0.666,P<0.05),Hunt-Hess classification(OR=0.177,95%CI=0.042-0.756,P<0.05),delayed cerebral ischemia(OR=0.288,95%CI=0.135-0.614,P<0.05),and pulmonary infection(OR=0.377,95%CI=0.159-0.900,P<0.05)were independent risk factors for poor prognosis in patients with ruptured anterior circulation RIA.Conclusion:Hypertension,diabetes,CT Fisher grade,Hunt-Hess grade,delayed cerebral ischemia,and pulmonary infection are independent risk factors affecting the prognosis of anterior circulatory RIA.By understanding and decreasing the risk factors of anterior circulatory RIA,it provides guidance for patients to obtain a good prognosis.