支架辅助栓塞颅内宽颈动脉瘤手术相关出血性与缺血性并发症的危险因素分析

Risk factors of procedure-related hemorrhagic and ischemic complications for stent-assisted coiling of wide-neck intracranial aneurysms

目的探讨支架辅助栓塞颅内宽颈动脉瘤手术相关并发症的危险因素。方法回顾性分析支架辅助栓塞治疗的颅内动脉瘤141例(共162个宽颈动脉瘤)的临床资料,分析手术相关出血、缺血性并发症的发生情况,并分别探讨两大并发症的相关危险因素。结果术中发生破裂出血7个,发生缺血性并发症11个。影响出血性并发症的有意义因素,单因素分析显示为动脉瘤形态是否规则与是否伴随血管痉挛,多因素Logistic回归分析提示为动脉瘤形态是否规则。影响缺血性并发症的有意义因素,单因素分析显示为是否伴随血管痉挛。结论支架辅助栓塞扩展了颅内动脉瘤血管内治疗的适应证,提高颅内动脉瘤治愈率,但手术相关出血与缺血性并发症亦应引起重视。了解并发症的危险因素并引起警惕,有助于规避并发症,提高手术安全性。

Objective To explore the risk factors of procedure-related complications of stent-assisted coiling for wide-neck intracranial aneurysms. Methods The clinical data of 141 patients with 162 wide-neck aneurysms treated by stent-assisted coiling embolization were analyzed retrospectively, including the risk factors for procedure-related hemorrhage and ischemic complications. Results Intra-procedure aneurysm rupture were observed in 7 aneurysms, and ischemic complications occurred in 11. For hemorrhagic complications, univariate analysis demonstrated that the significant factors were regularity of the aneurysmal morphology and occurrence of concomitant vasospasm,and multivariate logistic regression analysis showed that the regularity of the aneurysmal morphology was of significance. For ischemic complications, univariate analysis showed the significant factor was occurrence of concomitant vasospasm. Conclusions Stent-assisted coiling extend the indications of endovascular treatment for intracranial aneurysms and improve the cure rate of intracranial aneurysms. But the incidence of hemorrhagic and ischemic complications should be noticed. Understanding and paying attention to the risk factors for hemorrhagic and ischemic complications could help to avoid these complications and improve the safety for the operation.