Association between body mass index and intracranial procedural complications in patients undergoing endovascular treatment for unruptured aneurysms

Abstract

Background

The association between body mass index (BMI) and procedural intracranial complications in the endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) remains inadequately understood. While BMI is a well-established risk factor in cardiovascular and cerebrovascular disease, its specific role in the context of EVT for UIAs has not been clearly defined. Given the rising prevalence of obesity and the increased detection of UIAs through routine imaging, it is important to clarify whether BMI influences procedural safety or short-term outcomes following EVT.

Methods

This retrospective single-center study included consecutive patients with UIAs treated with EVT between April 2017 and April 2022. Patients were stratified into four BMI categories based on WHO classification: underweight (<18.5 kg/m²), normal (18.5–24.9), overweight (25.0–29.9), and obese (≥30.0). The primary outcome was any intracranial procedural complication (ischemic or hemorrhagic) occurring within 30 days of treatment. Secondary outcomes included symptomatic complications, complications requiring treatment, 30-day modified Rankin Scale (mRS) score of 0–2, and mortality. Multivariate logistic regression was performed adjusting for potential confounders, including sex, dyslipidemia, diabetes mellitus, wide neck, aneurysm location, and EVT technique. Subgroup analyses further evaluated BMI’s role in key risk strata.

Results

A total of 756 patients were included: 70 underweight (9.3 %), 481 normal weight (63.6 %), 163 overweight (21.6 %), and 42 obese (5.5 %). Procedural complications occurred in 46 cases (6.1 %), with ischemic events in 43 and hemorrhagic events in 3. There were no statistically significant differences in complication rates across BMI categories. Similarly, the 30-day favorable outcome rate (mRS 0–2) was high (96.0 %) and did not differ significantly by BMI. Subgroup analyses confirmed that BMI did not significantly impact complication rates when stratified by sex, aneurysm morphology, comorbidities, or treatment type. In multivariate analysis, only aneurysm neck size was independently associated with procedural complications (adjusted OR 1.21, 95 % CI 1.04–1.40; P = 0.02).

Conclusion

BMI was not significantly associated with procedural intracranial complications or short-term functional outcomes following EVT for UIAs. These findings suggest that EVT can be performed safely across BMI categories and that BMI alone should not influence patient selection or procedural planning. Future studies with larger, diverse populations and longer follow-up may provide further insight into the long-term implications of BMI in neuroendovascular procedures.