Stent-assisted coil embolization for unruptured wide-neck intracranial aneurysms:predictors of perioperative complications and recurrence
10.3760/cma.j.issn.1673-4165.2016.08.007
- VernacularTitle:支架辅助弹簧圈栓塞治疗未破裂颅内宽颈动脉瘤：围手术期并发症和复发的预测因素
- Author:
Chaobo LIU
;
Huanbin HUANG
;
Li REN
;
Xinjun ZHOU
- Publication Type:Journal Article
- Keywords:
Intracranial Aneurysm;
Embolization,Therapeutic;
Stents;
Recurrence;
Treatment Outcome;
Risk Factors
- From:
International Journal of Cerebrovascular Diseases
2016;24(8):722-729
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the feasibility, safety and effectiveness of stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms. Methods The clinical and imaging data of the patients with intracranial wide-necked aneurysm treated with stent-assisted coil embolization were analyzed retrospectively. Results A total of 200 patients with 205 aneurysms were enrolled. The mortality was 1. 5% and the disability rate was 1. 0% at discharge. One hundred seventy-seven patients were followed up for 16-51 months. The modified Rankin Scale scores: 0 in 174 cases, 2 in 2 cases, 4 in 1 case. Eleven patients (5. 5% ) had perioperative complications, including intraoperative bleeding in 3 cases, postoperative bleeding in 3 cases, postoperative cerebral infarction in 2 cases, coil protrusion in 2 cases, and postoperative epileptic seizure in 1 case. Univariate analysis showed that there were significant differences in the proportions of male patients (9. 1% vs. 5. 3% ; χ2 = 4. 42, P = 0. 026), hypertension (54. 5% vs. 23. 3% ; χ2 = 5. 42, P = 0. 03) and stent prior to coil implantation (54. 5% vs. 85. 1% ; χ2 = 3. 54, P =0. 021) between the complication group and the noncomplication group. Multivariate logistic regression analysis showed that the pre-stenting was an independent protective factor for surgery-related complications (odds ratio [OR] 0. 208, 95% confidence interval [CI] 0. 055-0. 791; P = 0. 021), and hypertension was an independent risk factor for surgery-related complications (OR 4. 380, 95% CI 1. 170-16. 399; P = 0. 028). The imaging follow-up of 167 aneurysms was obtained, including 26 recurrent aneurysms (15. 6% ). Univariate analysis showed that there was significant difference in the aneurysm site (anterior circulation aneurysms: 73. 1% vs. 89. 1% ; posterior circulation aneurysms: 26. 9% vs. 10. 6% ; χ2 = 5. 09, P = 0. 033) and size (giant aneurysms: 7. 7% vs. 0. 7% ; large artery aneurysm: 65. 4% vs. 29. 1% ; small aneurysms:26. 9% vs. 70. 2% ; χ2 = 20. 77, P < 0. 001) between the recurrence group and the nonrecurrence group. Multivariate logistic regression analysis showed that large aneurysms (OR 6. 057, 95% CI 2. 296-5. 983; P <0. 001), giant aneurysms (OR 25. 260, 95% CI 1. 903- 335. 267; P = 0. 014 ), and posterior circulation aneurysms ( OR 3. 184, 95% CI 1. 028- 9. 857; P = 0. 045 ) were the independent risk factors of postoperative recurrence. Conclusions Stent-assisted coil embolization is one of the effective methods for the treatment of complex wide-neck aneurysms. Hypertension and coils prior to stenting are the independent risk factors for perioperative complications, and larger aneurysm size and aneurysms in the posterior circulation are the independent risk factors for postoperative recurrence.
