Li Li, Zhang Xiaoxi, Feng Zhengzhe, Zhao Rui, Hong Bo, Xu Yi, Huang Qinghai, Liu Jianmin
Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China.
World Neurosurg. 2019 Mar;123:e9-e14. doi: 10.1016/j.wneu.2018.09.164. Epub 2018 Sep 29.
Intraprocedural rupture (IPR) is a rare complication that can occur during endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). However, it universally leads to poor outcomes if not properly managed. In the present study, we sought to illuminate the risk factors for IPR during EVT of UIAs.
The data from patients with UIAs who had undergone EVT in our center from January 2010 to March 2017 were retrospectively collected and reviewed. Univariate analysis and multivariate logistic analysis were performed to analyze the risk factors for IPR.
A total of 1232 patients with 1312 unruptured aneurysms were included in the present study. IPR occurred in 11 patients (0.9%). Univariate analysis showed that cardiac comorbidities, irregular morphology, and location at the anterior communicating artery (AcomA) were significantly associated with the development of IPR (P < 0.05). In addition, stent placement was related to a lower risk of IPR compared with no stent placement (P = 0.024). The multivariate analysis showed that cardiac comorbidities (odds ratio [OR], 6.320; P = 0.016), irregular morphology (OR, 9.562; P = 0.001), and location on the AcomA (OR, 6.971; P = 0.006) were independent risk factors for IPR.
The occurrence rate of IPR was relatively low. Cardiac comorbidities, irregular morphology, and location on the AcomA are independent risk factors for IPR. Stents and flow diverters are safe and feasible in treating UIA, with a significantly low risk of IPR.
术中破裂（IPR）是未破裂颅内动脉瘤（UIA）血管内治疗（EVT）过程中可能发生的一种罕见并发症。然而，如果处理不当，它通常会导致不良后果。在本研究中，我们试图阐明UIA的EVT过程中IPR的危险因素。
回顾性收集并分析了2010年1月至2017年3月在我们中心接受EVT的UIA患者的数据。进行单因素分析和多因素逻辑分析以分析IPR的危险因素。
本研究共纳入1232例患者的1312个未破裂动脉瘤。11例患者（0.9%）发生IPR。单因素分析显示，心脏合并症、不规则形态以及前交通动脉（AcomA）处的位置与IPR的发生显著相关（P<0.05）。此外，与未放置支架相比，放置支架与较低的IPR风险相关（P = 0.024）。多因素分析显示，心脏合并症（比值比[OR]，6.320；P = 0.016）、不规则形态（OR，9.562；P = 0.001）和位于AcomA处（OR，6.971；P = 0.006）是IPR的独立危险因素。
IPR的发生率相对较低。心脏合并症、不规则形态和位于AcomA处是IPR的独立危险因素。支架和血流导向装置在治疗UIA方面安全可行，IPR风险显著较低。
