颅内直径≤5 mm破裂动脉瘤血管内治疗术中再破裂的危险因素分析

Risk factors for rerupture of ruptured aneurysms with intracranialdiameter ≤5 mm during intravascular therapy

目的探讨颅内直径≤5mm破裂动脉瘤血管内治疗术中再破裂的危险因素。方法回顾性分析2019年7—2022年12月于如皋市人民医院收治的颅内直径≤5 mm破裂动脉瘤且进行血管内治疗的113例患者的临床资料。根据术中是否再破裂分为再破裂组与未再破裂组。采用多因素Logistic回归分析检验颅内直径≤5 mm破裂动脉瘤血管内治疗术中再破裂的危险因素。结果113例行血管内治疗术的颅内直径≤5 mm破裂动脉瘤患者中,根据DSA结果,其中术中再破裂11例(9.73%),未再破裂102例(90.27%)。高血压(OR=3.714,95%CI:1.331~6.285)、SBO(OR=4.052,95%CI:1.594~10.602)及重度ACAAS(OR=3.193,95%CI:1.158~16.521)是颅内直径≤5 mm破裂动脉瘤血管内治疗术中再破裂的独立危险因素(P<0.05)。ROC结果显示,预警评分系统预测颅内直径≤5 mm破裂动脉瘤血管内治疗术中再破裂的曲线下面积为0.731(95%CI:0.705~0.906),最佳截断值为6.0分,且预测术后复发的特异度为0.715,敏感度为0.902,Youden指数为0.617。结论对于行血管内治疗的颅内直径≤5 mm破裂动脉瘤患者,高血压、SBO及重度ACAAS可导致术中再破裂的风险增高。基于以上危险因素建立的风险预测评分系统有助于为临床治疗和短期预后预测提供依据。

Objective To investigate the risk factors of re-rupture of ruptured aneurysms with intracranial diameter≤5 mm during endovascular treatment.Methods Retrospective analysis was performed on the clinical data of 113 patients with ruptured intracranial aneurysms with diameter≤5mm who received endovascular treatment in our hospital from July 2019 to December 2022.The group was divided into two groups according to whether the operation was reruptured or not.Multivariate Logistic regression analysis was used to examine the risk factors of re-rupture of ruptured aneurysms with intracranial diameter≤5 mm during endovascular treatment.Results Among 113 patients with ruptured aneurysms with intracranial diameter≤5 mm who underwent endovascular therapy,according to the results of DSA,11 cases(9.73%)were re-ruptured during surgery,and 102(90.27%)cases were not re-ruptured.Hypertension(OR=3.714,95%CI:1.331-6.285),SBO(OR=4.052,95%CI:1.594-010.602)and severe ACAAS(OR=3.193,95%CI:1.158-016.521)were independent risk factors for re-rupture of ruptured aneurysms with intracranial diameter≤5 mm.ROC curve analysis results showed that the area under the curve of the early warning score system in predicting re-rupture of ruptured intracranial aneurysms with diameter≤5 mm was 0.731(95%CI:0.705-0.906),and the optimal cut-off value was 6.0 points.The sensitivity,specificity and Youden index for predicting postoperative recurrence were 0.902,0.715 and 0.617,respectively.Conclusion Hypertension,SBO and severe ACAAS can increase the risk of intraoperative rerupture in patients with ruptured intracranial aneurysm with diameter≤5 mm undergoing endovascular therapy.The risk prediction scoresystem basedontheaboveriskfactorscanprovideabasisforclinicaltreatmentandshort-term prognosisprediction.