Safety and efficacy of endovascular embolization combined with external drainage for poor-grade ruptured cerebral aneurysms

PurposeTo investigate the safety and efficacy of endovascular embolization combined with external drainage for poor-grade ruptured cerebral aneurysms and risk factors.Materials and methodsForty-six patients with poor-grade ruptured cerebral aneurysms treated with endovascular embolization combined with decompressive craniectomy and drainage were retrospectively enrolled.ResultsCoil embolization alone was performed in 29 (63.0%) patients, stent-assisted coiling in 14 (30.4%), and coiling with the assistance of two microcatheters in three (6.5%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 88% (44/50), II in 8% (4/50), and III in 4% (2/50). Periprocedural complications occurred in four (8.7%) patients. Forty-two (91.3%) patients had lumbar cistern drainage (n = 29 or 63.0%), extraventricular drainage (n = 11 or 23.9%), or decompressive craniectomy (n = 2 or 4.3%). At discharge, six (13.0%) patients died, and hydrocephalus took place in 16 (34.8%) patients. Better outcomes (mRS 0-2) were achieved in 31 (67.4%), including 23 (50.0%) patients below 60 years and eight (17.4%) over 60 years. Better clinical outcomes were achieved in patients below 60 years and with lumbar cistern drainage, and age was the only significant independent risk factor for better clinical outcomes. Receiver characteristics curve analysis of age for better clinical outcomes revealed that the cutoff value was 61 years, with the AUC 0.73, sensitivity 0.69, and specificity 0.73.ConclusionEndovascular embolization combined with decompressive craniectomy and drainage may be safe and efficient for poor-grade ruptured cerebral aneurysms, and older age and drainage modality may significantly affect the clinical outcomes.