颅内未破裂动脉瘤介入术后微缺血相关危险因素分析

Analysis of risk factors related to microischemia occurring after interventional treatment for unruptured intracranial aneurysms

目的探讨颅内未破裂动脉瘤(UIA)介入术后微缺血相关危险因素。方法收集2018年3月至2019年2月行介入治疗的110例UIA患者临床资料。术后3 d内患者接受头部MRI检查,根据弥散加权成像(DWI)有无急性微缺血病变分为DWI阳性组和DWI阴性组,比较两组患者微缺血发生率,单因素和多因素分析术后发生微缺血的危险因素。结果110例UIA患者中有56例(50.9%)出现微缺血病变。单因素分析结果显示,高血压史、瘤体直径大、氯吡格雷抵抗和支架辅助栓塞患者术后微缺血发生率更高(P<0.05)。多因素logistic回归分析结果显示,高血压史(OR=2.909,P=0.015,95%CI=1.233~6.862)、瘤体直径大(OR=2.590,P=0.033,95%CI=1.078~6.222)、氯吡格雷抵抗(OR=4.369,P=0.010,95%CI=1.419~13.456)和支架辅助栓塞(OR=3.474,P=0.045,95%CI=1.029~11.724)为微缺血独立危险因素。结论UIA介入术后微缺血发生率高,有高血压史、瘤体直径大、氯吡格雷抵抗和支架辅助栓塞患者发生率更高。应重视具有危险因素患者,予以针对性治疗,可能会降低微缺血发生率。

Objective To discuss the risk factors related to microischemia after the endovascular coil embolization for unruptured intracranial aneurysms(UIA).Methods The clinical data of 110 patients with UIA,who received interventional treatment during the period from March 2018 to February 2019,were retrospectively analyzed.MRI was performed within 3 days after treatment in all patients.According to the presence or absence of acute microischemic lesions on diffusion-weighted imaging(DWI),the patients were divided into positive group and negative group.The incidence of microischemia was compared between the two groups.Univariate analysis and multivariate analysis were used to analyze the risk factors for postoperative microischemia.Results Of the 110 UIA patients,56(50.9%)developed microischemic lesions.Univariate analysis showed that the incidence of post-intervention microischemia was higher in patients who had history of hypertension,large-diameter tumor,clopidogrel resistance and stent-assisted coil embolization(P<0.05).Multivariate logistic regression analysis indicated that history of hypertension(OR=2.909,95%CI=1.233-6.862,P=0.015),large-diameter tumor(OR=2.590,95%CI=1.078-6.222,P=0.033),clopidogrel resistance(OR=4.369,95%CI=1.419-13.456,P=0.010)and stent-assisted coil embolization(OR=3.474,95%CI=1.029-11.724,P=0.045)were the independent risk factors for microischemia.Conclusion The incidence of microischemia after endovascular coil embolization for UIA was higher.In these patients,who have history of hypertension,large-diameter aneurysms,clopidogrel resistance and stent-assisted coil embolization treatment,the incidence of post-intervention microischemia are much higher.High attention should be paid to the patients with risk factors,and timely and targeted treatment measures should be actively adopted,in this way the incidence of microischemia may be reduced.(J Intervent Radiol,2020,29:718-721)