颅内未破裂动脉瘤介入治疗程序相关性术中破裂的危险因素及临床特点分析

目的 探讨颅内未破裂动脉瘤介入治疗过程中发生术中破裂的危险因素及临床特点,为临床降低术中破裂的发生率提供对策.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,并对术中破裂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11例(0.89％)发生术中破裂.单因素分析结果显示心血管疾病史(P=o.025)、前交通动脉瘤(P=0.009)、肿瘤不规则形态(P=0.001)、支架应用(P=0.016)与术中破裂相关,多因素分析结果显示心血管疾病史(OR=6.919,P=0.008)、肿瘤不规则形态(OR=9.758,P＜0.001)、前交通动脉瘤(OR=4.648,P=0.024)为术中破裂的独立危险因素,支架应用为术中破裂的保护因素(OR=0.238,P=0.026).结论 心血管疾病史、不规则形态、前交通动脉瘤为颅内未破裂动脉瘤发生术中破裂的独立危险因素.支架治疗患者术中破裂的发生率低于非支架治疗患者.

Risk factors and clinical features of intra-procedural rupture in endovascular treatment of unruptured intracranial aneurysm

Objective To explore the risk factors and clinical features of intra-procedural rupture (IPR) in the interventional treatment of unruptured intracranial aneurysm (UIA), so as to reduce the incidence of IPR. Methods We retrospectively analyzed the clinical and imaging features of patients with UIA who received interventional treatment in Changhai Hospital, Second Military Medical University from Jan. 2010 to Feb. 2017. Univariate and multivariate analysis were performed to analyze the risk factors of IPR. Results A total of 1 232 patients with UIA were included in this study. IPR occurred in 11 patients (0.89%). Univariate analysis showed that cardiac comorbidities (P=0.025), anterior communicating artery aneurysm (P=0.009), irregular morphology (P=0.001), and the use of stents (P=0.016) were associated with IPR. Multivariate analysis showed that cardiac comorbidities (OR=6.919, P=0.008), irregular morphology (OR=9.758, P<0.001) and anterior communicating artery aneurysm (OR=4.648, P=0.024) were independent risk factors of IPR, while stents placement was a protective factor of IPR (OR=0.238, P=0.026). Conclusion Cardiac comorbidities, irregular morphology and anterior communicating artery aneurysm are independent risk factors of IPR in the interventional treatment of UIA. Stents and flow diverters are safe and feasible in treating UIAs, with low risk of IPR.