Impact of Aneurysm Shape on Intraoperative Rupture During Clipping of Ruptured Intracranial Aneurysms
Impact of Aneurysm Shape on Intraoperative Rupture During Clipping of Ruptured Intracranial Aneurysms
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DOI：
10.1016/j.wneu.2018.07.058
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发表时间：
2018-10-01
影响因子：
2
通讯作者：
Krischek, Boris
中科院分区：
文献类型：
--
作者：
Goertz, Lukas;Hamisch, Christina;Krischek, Boris
目的：不规则形状是颅内动脉瘤破裂引起蛛网膜下腔出血的已知危险因素。本研究的目的是确定显微手术夹持破裂动脉瘤时，动脉瘤形状对术中破裂（IOR）的影响。方法：这是一项回顾性的单中心研究，纳入了2010年至2017年期间连续接受夹持的患者。根据术前计算机断层扫描和数字减影血管造影的三维重建，将动脉瘤形状分为规则动脉瘤（RA）和不规则动脉瘤（IRA）。采用单因素和多因素统计分析确定IOR的危险因素。结果：共纳入138例RAs 32例，ira 102例。IRAs的尺寸大于RAs（分别为8.3 +/- 3.5 mm和4.6 +/- 2.3 mm, P < 0.001）。有36例IOR（26.1%）。IRAs组的IOR发生率高于RAs组（分别为31.1%比9.4%,P = 0.02）。在多变量分析中，IRA形状是IOR唯一显著的独立危险因素（优势比为3.9；95%可信区间为1.0-14.6;P = 0.047）。不良预后（改良Rankin量表评分大于2）与动脉瘤形状（P = 0.998）和IOR （P = 0.260）无显著相关性。结论：我们的研究结果表明，IRA形状是IOR的独立危险因素。在分析的患者队列中，动脉瘤形状和IOR对患者预后没有显著影响。
OBJECTIVE: Irregular shape is a known risk factor of intracranial aneurysm rupture causing subarachnoid hemorrhage. The objective of this study was to determine the impact of aneurysm shape on intraoperative rupture (IOR) during microsurgical clipping of ruptured aneurysms.METHODS: This is a retrospective, single-center study of consecutive patients that underwent clipping between 2010 and 2017. Based on 3-dimensional reconstructions from preoperative computed tomography scan and digital subtraction angiography, aneurysm shape was classified as regular aneurysm (RA) or irregular aneurysm (IRA). Risk factors for IOR were identified using univariate and multivariate statistical analyses.RESULTS: A total of 138 patients with 32 RAs and 102 IRAs were included in the analysis. IRAs had a larger size than RAs (8.3 +/- 3.5 vs. 4.6 +/- 2.3 mm, respectively; P < 0.001). There were 36 instances of IOR (26.1%). The IOR rate was greater in IRAs than in RAs (31.1% vs. 9.4%, respectively; P = 0.02). In multivariate analysis, IRA shape was the only significant independent risk factor for IOR (odds ratio, 3.9; 95% confidence interval, 1.0-14.6; P = 0.047). Unfavorable outcome (modified Rankin scale score greater than 2) was not significantly associated with aneurysm shape (P = 0.998) and IOR (P = 0.260).CONCLUSIONS: Our results demonstrate that IRA shape is an independent risk factor for IOR. In the analyzed patient cohort, aneurysm shape and IOR had no significant impact on patient prognosis.