颅内未破裂动脉瘤介入治疗术后神经系统并发症的危险因素分析

Risk factors of neurological complication after endovascular treatment of unruptured intracranial aneurysm

目的探讨颅内未破裂动脉瘤介入治疗术后神经系统并发症的危险因素,为临床降低神经系统并发症的发生提供对策。方法回顾性收集2010年1月至2017年1月间在海军军医大学(第二军医大学)长海医院接受介入治疗的颅内未破裂动脉瘤患者的临床资料,分析其临床及影像学特点,并应用单因素和多因素分析探寻神经系统并发症可能的危险因素。结果 1 196例患者中有60例(5.02%)发生神经系统并发症。单因素分析结果显示高血压病(P=0.026)、吸烟(P=0.038)、既往短暂性脑缺血发作或脑梗死病史(P<0.001)、心血管疾病(P=0.002)、动脉瘤最大径(P<0.001)、动脉瘤形态不规则或有子囊(P=0.008)、支架类型(P=0.001)与术后神经系统并发症的发生有关,多因素分析结果显示既往短暂性脑缺血发作或脑梗死病史(OR=3.407,P<0.001)、心血管疾病(OR=3.175,P=0.003)、动脉瘤最大径>10 mm(OR=3.139,P<0.001)和动脉瘤形态不规则或有子囊(OR=2.096,P=0.026)是术后神经系统并发症发生的独立危险因素。结论既往短暂性脑缺血发作或脑梗死病史、心血管疾病、动脉瘤最大径>10 mm和动脉瘤形态不规则或有子囊是未破裂颅内动脉瘤介入术后发生神经系统并发症的独立危险因素。

Objective To explore the risk factors of neurological complication(NC)after the endovascular treatment of unruptured intracranial aneurysm(UIA),so as to provide strategies for reducing the incidence of NC.Methods We retrospectively analyzed the clinical and imaging features of patients with UIA,who underwent endovascular treatment in Changhai Hospital,Navy Medical University(Second Military Medical University)from Jan.2010 to Jan.2017.Univariate analysis and multivariate logistic analysis were performed to analyze the risk factors of NC.Results NC occurred in 60(5.02%)of 1 196 patients with UIA in this study.Univariate analysis showed that hypertension(P=0.026),smoking(P=0.038),previous transient ischemic attack or cerebral infarction(P<0.001),cardiovascular comorbidities(P=0.002),aneurysm maximum diameter(P<0.001),irregular shape or having a daughter sac(P=0.008)and stent types(P=0.001)were associated with NC.Multivariate analysis showed that previous transient ischemic attack or cerebral infarction(OR=3.407,P<0.001),cardiovascular comorbidities(OR=3.175,P=0.003),aneurysm maximum diameter>10 mm(OR=3.139,P<0.001)and irregular shape or having a daughter sac(OR=2.096,P=0.026)were independent risk factors of NC.Conclusion Previous transient ischemic attack or cerebral infarction,cardiovascular comorbidities,aneurysm maximum diameter>10 mm and irregular shape or having a daughter sac are independent risk factors of NC after endovascular treatment of UIA.