Periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms

被引:4
作者
Han, Jiangli [1 ]
Liu, Fei [1 ,2 ]
Chen, Jigang [3 ]
Tong, Xin [3 ]
Han, Mingyang [1 ]
Peng, Fei [3 ]
Niu, Hao [3 ]
Liu, Lang [1 ]
Liu, Aihua [1 ,3 ]
机构
[1] Cent South Univ, Xiangya Hosp 3, Dept Neurosurg, Changsha, Peoples R China
[2] Sun Yat Sen Univ, Affiliated Hosp 5, Dept Neurosurg, Zhuhai, Peoples R China
[3] Capital Med Univ, Beijing Tiantan Hosp, Beijing Neurosurg Inst, Beijing, Peoples R China
基金
北京市自然科学基金; 中国国家自然科学基金;
关键词
dissecting aneurysm; endovascular treatment; flow diversion; complication; predictive factor; vertebral artery; endovascular neurosurgery; vascular disorders; COIL EMBOLIZATION; CLINICAL-OUTCOMES; FLOW DIVERTORS; PREDICTORS;
D O I
10.3171/2022.10.JNS221953
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE The authors undertook an evaluation of periprocedural cerebrovascular complications and 30-day out-comes of endovascular treatment for intracranial vertebral artery dissecting aneurysms (IVADAs) and assessed the relevant risk factors. METHODS The authors included a series of 195 patients who had undergone endovascular treatment for 198 IVADAs. Clinical data, morphological characteristics, treatment details, and periprocedural cerebrovascular complications includ-ing intraprocedural rupture, intraprocedural thrombosis, intracranial hemorrhage (ICH), transient ischemic attack (TIA), and ischemic stroke (IS) were recorded. After evaluation of the 30-day modified Rankin Scale (mRS) scores, the authors applied univariate and multivariate logistic regression analyses to identify the risk factors for complications and 30-day unfavorable clinical outcomes. RESULTS There were no intraprocedural ruptures, but the authors recorded intraprocedural thrombosis (n = 5), ICH (n = 3), TIA (n = 1), and IS (n = 13), comprising an 11.1% (22/198) complication rate. Multivariate logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.20-8.41, p = 0.020), IS history (OR 5.55, 95% CI 1.46-21.01, p = 0.012), and subarachnoid hemorrhage (SAH) (OR 4.48, 95% CI 1.52-13.20, p = 0.007) were risk factors for overall complications, whereas aneurysmal height (OR 0.77, 95% CI 0.61-0.98, p = 0.032) was a protective factor. SAH (OR 6.44, 95% CI 1.54-26.89, p = 0.011) and preprocedural mRS score > 2 (OR 5.07, 95% CI 1.01-25.59, p = 0.049) were independent risk factors for perforator occlusion stroke. Periprocedural cerebrovascular complications (OR 32.09, 95% CI 3.00-343.94, p = 0.004) and preprocedural mRS score > 2 (OR 319.92, 95% CI 30.28-3379.98, p < 0.001) were independent risk factors for 30-day unfavorable clinical outcomes. CONCLUSIONS Hyperlipidemia, IS history, and SAH were independent predictors for overall periprocedural cerebro-vascular complications of endovascular treatment for IVADAs, but aneurysmal height was an independent protective fac-tor. SAH and preprocedural mRS score > 2 were independent risk factors for perforator occlusion stroke. Preprocedural mRS score > 2 and periprocedural complications were independent risk factors for 30-day unfavorable clinical outcomes. https://thejns.org/doi/abs/10.3171/2022.10.JNS221953
引用
收藏
页码:1503 / 1511
页数:9
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