Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Radiology, McMaster University, Hamilton, Ontario, Canada.
J Neurointerv Surg. 2018 Apr;10(4):374-379. doi: 10.1136/neurintsurg-2017-013110. Epub 2017 Jun 26.
To determine the time to complications during and after elective endovascular intracranial aneurysm coiling.
A retrospective chart review of patients undergoing elective endovascular aneurysm coiling between March 2006 and October 2013 in one large Eastern Canadian Neurointerventional Service was performed. Data regarding the incidence, time and type of complication related to the endovascular coiling procedure and clinical outcome at last follow-up were collected. Patient, aneurysm and operation factors were analyzed to determine any factors associated with complication occurrence.
Of the 150 patient procedures analyzed, 16% experienced a coiling-related complication, although none resulted in death. 6.7% of patients experienced an intraoperative complication, of which thromboembolism was the most common type. The majority of the complications were detected in the first 6 hours after reversal of anesthesia, and a small proportion the next morning prior to discharge. Only 3.3% of patients had persistent neurological deficit after the procedure on last follow-up. Duration of the operation demonstrated a strong association with the occurrence of procedure-related complications.
This study demonstrates that coiling-related complications of elective endovascular coiling tend to occur either intraoperatively or are detected shortly after reversal of anesthesia. Further investigation with a larger cohort may help to guide important preoperative communication with patients and identify a select group of patients who may not necessarily require prolonged admission to hospital for observation.
确定择期血管内颅内动脉瘤弹簧圈栓塞术中及术后并发症的发生时间。
对 2006 年 3 月至 2013 年 10 月期间在加拿大东部一家大型神经介入服务机构接受择期血管内动脉瘤弹簧圈栓塞术的患者进行回顾性图表审查。收集与血管内弹簧圈栓塞术相关的并发症的发生率、时间和类型以及最后一次随访时的临床结果的数据。分析患者、动脉瘤和手术因素，以确定与并发症发生相关的任何因素。
在分析的 150 例患者手术中，16%的患者发生了与弹簧圈相关的并发症，但无死亡病例。6.7%的患者发生了术中并发症，其中血栓栓塞是最常见的类型。大多数并发症是在麻醉逆转后 6 小时内发现的，一小部分是在第二天早上出院前发现的。只有 3.3%的患者在最后一次随访时有持续的神经功能缺损。手术持续时间与手术相关并发症的发生有很强的关联。
本研究表明，择期血管内弹簧圈栓塞的弹簧圈相关并发症倾向于在术中发生或在麻醉逆转后不久被发现。进一步的大样本研究可能有助于指导与患者进行重要的术前沟通，并确定可能不一定需要延长住院观察的特定患者群体。
