Endovascular Treatment for Ruptured Intracranial Posterior Circulation Aneurysms: Complications and Clinical Outcomes.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-04 DOI:10.1016/j.wneu.2024.09.067

Jinshuo Yang, Qiaowei Wu, Zhiyong Ji, Chunlei Wang, Pei Wu, Guang Zhang, Chao Xu, Chunxu Li, Yujing Zhu, Feifan Zhang, Huaizhang Shi, Shancai Xu

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引用次数: 0

Abstract

Objective: To analyze the complications and long-term follow-up results of endovascular treatment for ruptured intracranial posterior circulation aneurysms and identify outcome predictors.

Methods: A total of 194 patients with ruptured intracranial posterior circulation aneurysms treated at our center between January 2014 and June 2023 were included in this retrospective analysis. Factors influencing complications during hospitalization and clinical and angiographic outcomes were analyzed.

Results: Complications occurred in 57 patients (29.4%) during hospitalization. The median clinical follow-up time was 46.5 (interquartile range 26.0-65.3) months, with favorable outcomes observed in 81.4% (158/194) and unfavorable outcomes in 18.5% (36/194) of cases, resulting in an overall mortality rate of 11.9% (23/194). The overall 1-year and 5-year complication-free survival rates were 76.4% and 70.7%, respectively. The overall 1-year and 5-year overall survival rates were 89.5% and 85.4%, respectively. Multifactorial analysis revealed that involvement of the basilar artery (P = 0.032) and perioperative external ventricular drainage (P < 0.001) were independent risk factors for complications during hospitalization, while advanced age (P = 0.030), poor World Federation of Neurosurgical Societies grade (P = 0.003), and use of closed cell design laser cut stents (P = 0.041) were independent risk factors for unfavorable outcomes during follow-up. Among the survivors, angiography follow-up was available for 139 patients, with a follow-up rate of 81.3% (139/171) and a median follow-up time of 8 months (interquartile range 6-12). During this period, 9 patients experienced aneurysm recanalization, and the complete occlusion rate was 85.6% (119/139).

Conclusion: Endovascular treatment is feasible and effective for treating ruptured intracranial aneurysms; however, there are still risks of complications and unfavorable clinical outcomes. The involvement of the basilar artery trunk increases the risk of complications, and the use of closed cell design laser cut stents is associated with unfavorable outcomes. Clinicians should be cautious to avoid the risk factors when treating ruptured posterior circulation aneurysms and strive to minimize the occurrence of complications and unfavorable clinical outcomes.

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颅内后循环动脉瘤破裂的血管内治疗：并发症和临床结果。

目的分析血管内治疗颅内后循环动脉瘤破裂的并发症和长期随访结果，并确定结果预测因素：本回顾性分析纳入了 2014 年 1 月至 2023 年 6 月期间在本中心接受治疗的 194 例颅内后循环动脉瘤破裂患者。分析了住院期间并发症的影响因素以及临床和血管造影结果：57名患者（29.4%）在住院期间出现并发症。中位临床随访时间为 46.5 个月（IQR 26.0-65.3），81.4% 的病例（158/194）观察到良好的结果，18.5% 的病例（36/194）观察到不良结果，总死亡率为 11.9%（23/194）。1年和5年无并发症生存率分别为76.4%和70.7%。1年和5年总生存率分别为89.5%和85.4%。多因素分析显示，基底动脉受累（p=0.032）和围手术期心室外引流（pConclusion：血管内治疗对治疗颅内动脉瘤破裂是可行且有效的，但仍存在并发症和不利临床结果的风险。BA 主干受累会增加并发症的风险，而使用封闭式设计的激光切割支架则与不利的结果有关。临床医生在治疗破裂的后循环动脉瘤时应谨慎规避风险因素，努力将并发症和不良临床结果的发生率降至最低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.