Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Clin Neurol Neurosurg. 2020 Aug;195:105884. doi: 10.1016/j.clineuro.2020.105884. Epub 2020 May 4.
Temporary clipping of the internal carotid artery can be required during microsurgery of a ruptured anterior choroidal artery (AchoA) aneurysm. Although it is suspected that such temporary clipping might be related to ischemic complications following surgery, no detailed analysis has been reported yet.
Eighty-nine patients with ruptured AchoA aneurysms treated by microsurgical clipping were recruited between January 1996 and December 2017. Patient medical records, radiographic data, and intraoperative video findings were retrospectively reviewed. Multivariate logistic regression analysis was conducted to investigate the risk factors for treatment-related ischemic complications.
Treatment-related ischemic complications occurred in eight (9.0 %) patients, all of whom underwent temporary clipping during microsurgery. Patients who did not undergo temporary clipping (n = 20) did not experience treatment-related ischemic complications. Among patients who underwent temporary clipping (n = 69), multivariate logistic regression analyses indicated that the total duration, number of attempts, and longest time per attempt were not risk factors for poor clinical outcome at discharge. However, the longest time per attempt was identified as the only independent risk factor for treatment-related ischemic complications (odds ratio, 2.883; 95 % confidence interval, 1.725-6.525; P = 0.042).
The longest time per attempt might be associated with a higher risk of treatment-related ischemic complications during microsurgery for ruptured AchoA aneurysms. Treatment-related ischemic complications may be minimized by intermittent application of temporary clipping during surgery.
在破裂的脉络膜前动脉（AchoA）动脉瘤的显微手术中，可能需要临时夹闭颈内动脉。尽管据推测，这种临时夹闭可能与手术后的缺血性并发症有关，但目前尚未进行详细分析。
1996 年 1 月至 2017 年 12 月，共招募了 89 例接受显微夹闭治疗的破裂 AchoA 动脉瘤患者。回顾性分析患者的病历、影像学资料和术中录像。采用多变量 logistic 回归分析来探讨与治疗相关的缺血性并发症的危险因素。
8 例（9.0%）患者在显微手术中发生与治疗相关的缺血性并发症，均行临时夹闭。未行临时夹闭的患者（n=20）未发生与治疗相关的缺血性并发症。在接受临时夹闭的患者中（n=69），多变量 logistic 回归分析表明，总时间、尝试次数和每次尝试的最长时间不是出院时临床预后不良的危险因素。然而，每次尝试的最长时间是与治疗相关的缺血性并发症的唯一独立危险因素（比值比，2.883；95%置信区间，1.725-6.525；P=0.042）。
每次尝试的最长时间可能与破裂的 AchoA 动脉瘤显微手术中与治疗相关的缺血性并发症的风险增加有关。通过在手术中间歇性应用临时夹闭，可能使与治疗相关的缺血性并发症最小化。
