Yang Cheng, Zhao Zenan, Zheng Yuanwen, Yang Biao, Zhu Gang, Miao Hongping
Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
Department of Neurosurgery, Chongqing Western Hospital, Chongqing, 400052, China.
Neurosurg Rev. 2025 May 3;48(1):402. doi: 10.1007/s10143-025-03557-3.
Surgery-related cerebral infarction (SRCI) is an important complication after aneurysmal subarachnoid hemorrhage (aSAH), and detailed assessment of the characteristics and risk of SRCI is insufficient. We aimed to analyze the risk factors for SRCI in different treatment modalities after aSAH. A total of 472 patients were included in this retrospective study, including 169 in clip and 303 in endovascular. Regarding radiologically observable SRCI as the outcome, we used univariate and multivariate statistical analyses of risk factors and summarized the characteristics of SRCI. The incidence of SRCI was significantly higher in the clipping group compared to the endovascular group (47% vs. 21%, p < 0.001). Patients with SRCI in clip group had higher HH (p = 0.007) and mFisher (p = 0.007) and more diabetics (p = 0.018). They were more likely to receive primary EVD (p < 0.001), decompressive craniectomy (p = 0.022), multiple aneurysms repair (p = 0.008), and had longer procedure time (p = 0.006). Patients with SRCI in endovascular group were older (p = 0.001), more hypertensive (p = 0.001), with higher HH (p = 0.034) and longer procedure time (p = 0.005). They were more likely to presented with acute hydrocephalus (p = 0.030), type-3 aortic arch in pathway (p = 0.009) and proximal stenosis of the parent artery (p = 0.045). Multivariate regression analysis identified diabetes (OR = 7.050, 95%CI: 1.303-38.158), primary EVD (OR = 4.066, 95%CI: 1.567-10.550), longer procedure time (OR = 1.007, 95%CI: 1.001-1.013), and repair multiple aneurysms (OR = 3.916, 95%CI: 1.142-13.432) independently predicted SRCI in clip group. Age (OR = 1.033, 95%CI: 1.001-1.066), hypertension (OR = 2.337, 95%CI: 1.220-4.478), type-3 aortic arch in pathway (OR = 4.010, 95%CI: 1.177-13.666), and proximal stenosis of parent artery (OR = 2.442, 95%CI: 1.015-5.875) independently predicted SRCI in endovascular group. Diabetes, primary EVD, longer procedure time, and repair multiple aneurysms were independent risk factors for SRCI in clip group. In contrast, age, hypertension, type-3 aortic arch in pathway, and proximal stenosis of parent artery were independent risk factors for SRCI in endovascular group.
手术相关性脑梗死（SRCI）是动脉瘤性蛛网膜下腔出血（aSAH）后的一种重要并发症，目前对SRCI的特征和风险的详细评估尚不充分。我们旨在分析aSAH后不同治疗方式下SRCI的危险因素。本回顾性研究共纳入472例患者，其中夹闭术组169例，血管内介入组303例。以影像学可观察到的SRCI作为结局，我们对危险因素进行单因素和多因素统计分析，并总结SRCI的特征。夹闭术组的SRCI发生率显著高于血管内介入组（47%对21%，p<0.001）。夹闭术组发生SRCI的患者有更高的HH评分（p=0.007）和改良Fisher评分（p=0.007），且糖尿病患者更多（p=0.018）。他们更有可能接受一期脑室外引流（EVD）（p<0.001）、去骨瓣减压术（p=0.022）、多个动脉瘤修复（p=0.008），且手术时间更长（p=0.006）。血管内介入组发生SRCI的患者年龄更大（p=0.001）、高血压患者更多（p=0.001），有更高的HH评分（p=0.034）和更长的手术时间（p=0.005）。他们更有可能出现急性脑积水（p=0.030）、路径中有3型主动脉弓（p=0.009）和载瘤动脉近端狭窄（p=0.045）。多因素回归分析确定糖尿病（OR=7.050，95%CI：1.303-38.158）、一期EVD（OR=4.066，95%CI：1.567-10.550）、更长的手术时间（OR=1.007，95%CI：1.001-1.013）和修复多个动脉瘤（OR=3.916，95%CI：1.142-13.432）独立预测夹闭术组的SRCI。年龄（OR=1.033，95%CI：1.001-1.066）、高血压（OR=2.337，95%CI：1.220-4.478）、路径中有3型主动脉弓（OR=4.010，95%CI：1.177-13.666）和载瘤动脉近端狭窄（OR=2.442，95%CI：1.015-5.875）独立预测血管内介入组的SRCI。糖尿病、一期EVD、更长的手术时间和修复多个动脉瘤是夹闭术组SRCI的独立危险因素。相比之下，年龄、高血压、路径中有3型主动脉弓和载瘤动脉近端狭窄是血管内介入组SRCI的独立危险因素。
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