Reconstructive Endovascular Treatment of Intracranial Ruptured Posterior Circulation Aneurysms Located on Small Arteries: Complications and Long-Term Results.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2024-12-05 DOI:10.1016/j.wneu.2024.11.056

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

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Abstract

Objective: Assess the complications, clinical outcomes, and angiographic results of endovascular treatment (EVT) for ruptured intracranial posterior circulation aneurysms in small arteries, and identify their risk factors.

Methods: We conducted a retrospective analysis of 79 patients with ruptured posterior circulation aneurysms in small arteries (the diameter of the parent artery was ≤2 mm) treated at our hospital between January 2014 and August 2023. All patients received EVT. The study examined risk factors associated with in-hospital complications and clinical outcomes.

Results: The incidence of in-hospital complications among all patients receiving reconstructive EVT was 30.4% (24/79). The median clinical follow-up time of the patients was 45 months (interquartile range: 28-65 months). Favorable clinical outcomes were observed in 83.5% (66/79) of patients, while the overall mortality rate was 11.4% (9/79). Of the 75 survivors, 59 (78.7%) underwent angiographic follow-up, revealing a median follow-up time of 11 months (interquartile range: 6-12 months) and a complete occlusion rate of 84.7% (50/59). Residual aneurysms occurred in 6.8% (4/59) of patients. Survival analysis indicated 1- and 3-year complication-free survival rates of 70.9% and 65.5%, respectively, and overall 1- and 3-year survival rates of 89.6% and 87.6%. Multivariate analysis identified external ventricular drainage (P = 0.007) as an independent risk factor for in-hospital complications. Older age (P = 0.024) and a World Federation of Neurosurgical Societies grade of 4-5 (P < 0.001) were independent risk factors for unfavorable clinical outcomes.

Conclusions: Reconstructive EVT for ruptured intracranial posterior circulation small artery aneurysms was generally safe and effective. However, the risk of complications and unfavorable clinical outcomes persisted. External ventricular drainage was a significant risk factor for in-hospital complications, whereas older age and higher World Federation of Neurosurgical Societies grades were predictors of unfavorable clinical outcomes.

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位于小动脉上的颅内后循环破裂动脉瘤的血管内重建治疗：并发症和长期效果。

摘要评估小动脉颅内后循环动脉瘤破裂的并发症、临床结果和血管造影结果，并确定其风险因素：我们对2014年1月至2023年8月期间在我院接受治疗的79例小动脉后循环动脉瘤破裂（母动脉直径小于2毫米）患者进行了回顾性分析。所有患者均接受了血管内治疗。研究考察了与院内并发症和临床结果相关的风险因素：所有接受血管内重建治疗的患者中，院内并发症的发生率为12.7%（10/79）。患者的随访时间中位数为 45 个月（IQR 28-65），总并发症发生率为 38.0%。85.3%（66/79）的患者获得了良好的临床效果，而死亡率为 11.4%（9/79）。在 70 名幸存者中，59 人（84.3%）接受了血管造影随访，中位随访时间为 11 个月（IQR 6-12），完全闭塞率为 84.7%（50/70）。6.8%的患者（4/59）发生了动脉瘤再闭塞。生存分析显示，1 年和 3 年无并发症生存率分别为 70.9% 和 65.5%，1 年和 3 年总生存率分别为 89.6% 和 87.6%。多变量分析发现，发病 72 小时内手术（p=0.043）和心室外引流（p=0.023）是院内并发症的独立风险因素。年龄较大（p=0.024）和 WFNS 分级为 4-5 级（pConclusion：颅内后循环小动脉瘤破裂的重建性血管内治疗通常是安全有效的。然而，并发症和不利临床结果的风险依然存在。动脉瘤破裂后 72 小时内尽早手术和脑室外引流是院内并发症的重要风险因素，而年龄较大和 WFNS 分级较高是临床预后较差的预测因素。

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

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS