Yang Jinshuo, Wu Qiaowei, Ji Zhiyong, Wang Chunlei, Wu Pei, Zhang Guang, Xu Chao, Li Chunxu, Zhu Yujing, Zhang Feifan, Shi Huaizhang, Xu Shancai
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
World Neurosurg. 2025 Jan;193:1089-1098. doi: 10.1016/j.wneu.2024.09.067. Epub 2024 Oct 4.
To analyze the complications and long-term follow-up results of endovascular treatment for ruptured intracranial posterior circulation aneurysms and identify outcome predictors.
A total of 194 patients with ruptured intracranial posterior circulation aneurysms treated at our center between January 2014 and June 2023 were included in this retrospective analysis. Factors influencing complications during hospitalization and clinical and angiographic outcomes were analyzed.
Complications occurred in 57 patients (29.4%) during hospitalization. The median clinical follow-up time was 46.5 (interquartile range 26.0-65.3) months, with favorable outcomes observed in 81.4% (158/194) and unfavorable outcomes in 18.5% (36/194) of cases, resulting in an overall mortality rate of 11.9% (23/194). The overall 1-year and 5-year complication-free survival rates were 76.4% and 70.7%, respectively. The overall 1-year and 5-year overall survival rates were 89.5% and 85.4%, respectively. Multifactorial analysis revealed that involvement of the basilar artery (P = 0.032) and perioperative external ventricular drainage (P < 0.001) were independent risk factors for complications during hospitalization, while advanced age (P = 0.030), poor World Federation of Neurosurgical Societies grade (P = 0.003), and use of closed cell design laser cut stents (P = 0.041) were independent risk factors for unfavorable outcomes during follow-up. Among the survivors, angiography follow-up was available for 139 patients, with a follow-up rate of 81.3% (139/171) and a median follow-up time of 8 months (interquartile range 6-12). During this period, 9 patients experienced aneurysm recanalization, and the complete occlusion rate was 85.6% (119/139).
Endovascular treatment is feasible and effective for treating ruptured intracranial aneurysms; however, there are still risks of complications and unfavorable clinical outcomes. The involvement of the basilar artery trunk increases the risk of complications, and the use of closed cell design laser cut stents is associated with unfavorable outcomes. Clinicians should be cautious to avoid the risk factors when treating ruptured posterior circulation aneurysms and strive to minimize the occurrence of complications and unfavorable clinical outcomes.
分析破裂性颅内后循环动脉瘤血管内治疗的并发症及长期随访结果，并确定预后预测因素。
本回顾性分析纳入了2014年1月至2023年6月在本中心接受治疗的194例破裂性颅内后循环动脉瘤患者。分析了影响住院期间并发症以及临床和血管造影结果的因素。
57例患者（29.4%）在住院期间发生并发症。临床随访时间中位数为46.5（四分位间距26.0 - 65.3）个月，81.4%（158/194）的病例预后良好，18.5%（36/194）的病例预后不良，总死亡率为11.9%（23/194）。1年和5年的总体无并发症生存率分别为76.4%和70.7%。1年和5年的总体生存率分别为89.5%和85.4%。多因素分析显示，基底动脉受累（P = 0.032）和围手术期脑室外引流（P < 0.001）是住院期间并发症的独立危险因素，而高龄（P = 0.030）、世界神经外科联盟分级差（P = 0.003）以及使用闭孔设计激光切割支架（P = 0.041）是随访期间预后不良的独立危险因素。在幸存者中，139例患者进行了血管造影随访，随访率为81.3%（139/171），随访时间中位数为8个月（四分位间距6 - 12）。在此期间，9例患者出现动脉瘤再通，完全闭塞率为85.6%（119/139）。
血管内治疗破裂性颅内动脉瘤可行且有效；然而，仍存在并发症和不良临床结局的风险。基底动脉主干受累会增加并发症风险，使用闭孔设计激光切割支架与不良结局相关。临床医生在治疗破裂性后循环动脉瘤时应谨慎避免危险因素，努力将并发症和不良临床结局的发生降至最低。
