颅内未破裂动脉瘤血管内介入治疗程序相关性缺血性并发症的危险因素及临床特点分析

目的 分析颅内未破裂动脉瘤血管内介入治疗过程中发生缺血性并发症的危险因素及临床特点，为临床降低缺血性并发症的发生率提供依据。方法 回顾性收集2010年1月至2017年2月间在第二军医大学长海医院接受血管内介入治疗的1 232例颅内未破裂动脉瘤患者的临床资料，分析其临床及影像学特点，并对缺血性并发症可能的危险因素行单因素和多因素分析。结果 1 232例患者中有34例（2.8%）发生缺血性并发症，其中急性支架内血栓形成16例、术后症状性脑梗死15例、短暂性脑缺血发作3例。单因素分析结果显示高血压病（P=0.002）、吸烟（P=0.050）、动脉瘤最大径>10 mm（P=0.005）与缺血性并发症有关，多因素分析结果显示高血压病（OR=3.192，P=0.003）、吸烟（OR=2.956，P=0.022）、动脉瘤最大径>10 mm（OR=2.915，P=0.004）为缺血性并发症的独立危险因素。缺血性并发症的永久性致残率和致死率分别为8.8%（3/34）和2.9%（1/34）。结论 高血压病、吸烟、动脉瘤最大径>10 mm是颅内未破裂动脉瘤血管内介入治疗过程中发生缺血性并发症的独立危险因素。

Risk factors and clinical features of ischemic complication in endovascular treatment of unruptured intracranial aneurysm

Objective To analyzed the risk factors and clinical features of ischemic complication (IC) in the endovascular treatment (EVT) of unruptured intracranial aneurysm (UIA), so as to reduce the incidence of IC. Methods We retrospectively analyzed the clinical and imaging features of 1 232 patients with UIA, who received EVT in Changhai Hospital, Second Military Medical University from Jan. 2010 to Feb. 2017. Univariate and multivariate analyses were performed to analyze the risk factors of IC. Results IC occurred in 34 (2.8%) of 1 232 patients with UIA in this study, including 16 cases of acute stent thrombus formation, 3 cases of transient ischemic attack, and 15 cases of post-operative cerebral infarction. Univariate analysis showed that hypertension (P=0.002), smoking (P=0.050), and aneurysm maximum diameter>10 mm (P=0.005) were associated with IC. Multivariate analysis showed that hypertension (OR=3.192, P=0.003), smoking (OR=2.956, P=0.022) and aneurysm maximum diameter>10 mm (OR=2.915, P=0.004) were independent risk factors of IC. The permanent disability rate and mortality rate of IC were 8.8% (3/34) and 2.9% (1/34), respectively. Conclusion Hypertension, smoking and aneurysm maximum diameter>10 mm are independent risk factors of IC in the EVT of UIA.