Elijovich Lucas, Higashida Randall T, Lawton Michael T, Duckwiler Gary, Giannotta Steven, Johnston S Claiborne
Department of Neurology, University of California San Francisco, San Francisco, CA 94143-0114, USA.
Stroke. 2008 May;39(5):1501-6. doi: 10.1161/STROKEAHA.107.504670. Epub 2008 Mar 6.
Intraprocedural rupture (IPR) is a well known complication of intracranial aneurysm treatment. Risks and predictors of IPR and its impact on outcome have not been clearly established.
Potential predictors of IPR were evaluated in patients treated in the Cerebral Aneurysm Rerupture After Treatment (CARAT) study using multivariate logistic regression with stepwise elimination stratified by treatment modality. Periprocedural death or disability was defined as death or a change of >or=2 points on the Modified Rankin Scale at discharge compared to before treatment.
IPR occurred in 14.6% of 1010 patients (299 coiled, 711 clipped): 19% with clipping and 5% with coiling (P<0.001). Among those clipped, 31% with IPR had periprocedural death or disability compared to 18% without IPR (P=0.001); among those coiled, 63% with IPR had periprocedural death or disability compared to 15% without IPR (P<0.001). Overall, coronary artery disease and initial lower Hunt and Hess Grade were independent predictors of IPR. For those undergoing coiling, independent predictors of IPR were Asian race, black race, COPD, and lower initial Hunt and Hess Grade. Among those undergoing clipping, hyperlipidemia and lower initial Hunt and Hess Grade were both independent predictors of IPR.
IPR was common in patients undergoing treatment of ruptured aneurysms, particularly with surgical clipping. The frequency of IPR with new disability was similar in the surgical and endovascular treatment groups. Coronary artery disease, hyperlipidemia, race, COPD, and lower Hunt and Hess Grade were associated with greater risk of IPR, which may reflect differences in vessel fragility but requires further confirmation.
术中破裂（IPR）是颅内动脉瘤治疗中一种众所周知的并发症。IPR的风险、预测因素及其对预后的影响尚未明确。
在治疗后脑动脉瘤再破裂（CARAT）研究中接受治疗的患者中，使用多因素逻辑回归并按治疗方式分层逐步排除法评估IPR的潜在预测因素。围手术期死亡或残疾定义为与治疗前相比出院时死亡或改良Rankin量表评分变化≥2分。
1010例患者（299例采用弹簧圈栓塞，711例采用夹闭术）中有14.6%发生IPR：夹闭术组为19%，弹簧圈栓塞组为5%（P<0.001）。在夹闭术患者中，发生IPR的患者有31%出现围手术期死亡或残疾，未发生IPR的患者为18%（P=0.001）；在弹簧圈栓塞患者中，发生IPR的患者有63%出现围手术期死亡或残疾，未发生IPR的患者为15%（P<0.001）。总体而言，冠状动脉疾病和初始Hunt和Hess分级较低是IPR的独立预测因素。对于接受弹簧圈栓塞的患者，IPR的独立预测因素为亚洲种族、黑人种族、慢性阻塞性肺疾病（COPD）和初始Hunt和Hess分级较低。在接受夹闭术的患者中，高脂血症和初始Hunt和Hess分级较低均为IPR的独立预测因素。
IPR在破裂动脉瘤治疗患者中很常见，尤其是手术夹闭时。手术和血管内治疗组中伴有新残疾的IPR发生率相似。冠状动脉疾病、高脂血症、种族、COPD以及较低的Hunt和Hess分级与IPR风险增加有关，但这可能反映了血管脆性的差异，需要进一步证实。
