Matsukawa Hidetoshi, Kazekawa Kiyoshi, Yasaka Masahiro, Fukui Yoshimasa, Maruyama Kosei, Fujii Takashi, Takigawa Kosuke, Tashiro Noriaki, Hashiguchi Yoshiya, Aikawa Hiroshi, Go Yoshinori
Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan.
Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Fukuoka, Japan.
J Clin Neurosci. 2025 Aug;138:111402. doi: 10.1016/j.jocn.2025.111402. Epub 2025 Jun 17.
The association between body mass index (BMI) and procedural intracranial complications in the endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) remains inadequately understood. While BMI is a well-established risk factor in cardiovascular and cerebrovascular disease, its specific role in the context of EVT for UIAs has not been clearly defined. Given the rising prevalence of obesity and the increased detection of UIAs through routine imaging, it is important to clarify whether BMI influences procedural safety or short-term outcomes following EVT.
This retrospective single-center study included consecutive patients with UIAs treated with EVT between April 2017 and April 2022. Patients were stratified into four BMI categories based on WHO classification: underweight (<18.5 kg/m), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). The primary outcome was any intracranial procedural complication (ischemic or hemorrhagic) occurring within 30 days of treatment. Secondary outcomes included symptomatic complications, complications requiring treatment, 30-day modified Rankin Scale (mRS) score of 0-2, and mortality. Multivariate logistic regression was performed adjusting for potential confounders, including sex, dyslipidemia, diabetes mellitus, wide neck, aneurysm location, and EVT technique. Subgroup analyses further evaluated BMI's role in key risk strata.
A total of 756 patients were included: 70 underweight (9.3 %), 481 normal weight (63.6 %), 163 overweight (21.6 %), and 42 obese (5.5 %). Procedural complications occurred in 46 cases (6.1 %), with ischemic events in 43 and hemorrhagic events in 3. There were no statistically significant differences in complication rates across BMI categories. Similarly, the 30-day favorable outcome rate (mRS 0-2) was high (96.0 %) and did not differ significantly by BMI. Subgroup analyses confirmed that BMI did not significantly impact complication rates when stratified by sex, aneurysm morphology, comorbidities, or treatment type. In multivariate analysis, only aneurysm neck size was independently associated with procedural complications (adjusted OR 1.21, 95 % CI 1.04-1.40; P = 0.02).
BMI was not significantly associated with procedural intracranial complications or short-term functional outcomes following EVT for UIAs. These findings suggest that EVT can be performed safely across BMI categories and that BMI alone should not influence patient selection or procedural planning. Future studies with larger, diverse populations and longer follow-up may provide further insight into the long-term implications of BMI in neuroendovascular procedures.
在未破裂颅内动脉瘤（UIA）的血管内治疗（EVT）中，体重指数（BMI）与手术相关颅内并发症之间的关联仍未得到充分理解。虽然BMI是心血管和脑血管疾病中公认的危险因素，但其在UIA的EVT背景下的具体作用尚未明确界定。鉴于肥胖患病率的上升以及通过常规影像学检查发现的UIA增多，明确BMI是否会影响EVT后的手术安全性或短期预后很重要。
这项回顾性单中心研究纳入了2017年4月至2022年4月期间接受EVT治疗的连续UIA患者。根据世界卫生组织的分类，将患者分为四个BMI类别：体重过轻（<18.5kg/m²）、正常（18.5 - 24.9）、超重（25.0 - 29.9）和肥胖（≥30.0）。主要结局是治疗后30天内发生的任何颅内手术并发症（缺血性或出血性）。次要结局包括有症状的并发症、需要治疗的并发症、30天改良Rankin量表（mRS）评分为0 - 2以及死亡率。进行多因素逻辑回归分析以调整潜在的混杂因素，包括性别、血脂异常、糖尿病、宽颈、动脉瘤位置和EVT技术。亚组分析进一步评估了BMI在关键风险分层中的作用。
共纳入756例患者：70例体重过轻（9.3%），481例体重正常（63.6%），163例超重（21.6%），42例肥胖（5.5%）。46例（6.1%）发生了手术并发症，其中43例为缺血性事件，3例为出血性事件。不同BMI类别之间的并发症发生率无统计学显著差异。同样，30天良好结局率（mRS 0 - 2）很高（96.0%），且在不同BMI之间无显著差异。亚组分析证实，按性别、动脉瘤形态、合并症或治疗类型分层时，BMI对并发症发生率无显著影响。在多因素分析中，只有动脉瘤颈部大小与手术并发症独立相关（调整后的OR为1.21，95%CI为1.04 - 1.40；P = 0.02）。
BMI与UIA的EVT后手术相关颅内并发症或短期功能结局无显著关联。这些发现表明，EVT可在不同BMI类别中安全进行，仅BMI不应影响患者选择或手术规划。未来对更大、更多样化人群进行更长时间随访的研究可能会进一步深入了解BMI在神经血管介入手术中的长期影响。
