White Matter Lesions as Brain Frailty and Age are Risk Factors for Surgical Clipping of Unruptured Intracranial Aneurysms in the Elderly.
White Matter Lesions as Brain Frailty and Age are Risk Factors for Surgical Clipping of Unruptured Intracranial Aneurysms in the Elderly.
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105121
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
Fumihiro Matano;T. Mizunari;Y. Murai;T. Tamaki;Kojiro Tateyama;Masanori Suzuki;A. Morita
中科院分区：
文献类型：
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作者：
Fumihiro Matano;T. Mizunari;Y. Murai;T. Tamaki;Kojiro Tateyama;Masanori Suzuki;A. Morita
我们的目的是确定手术治疗bb0 - 60岁人群未破裂颅内动脉瘤（UIAs）的危险因素，特别是白质病变（WMLs）。材料与方法我们调查了214例UIAs患者。患者组男性53例，女性151例，平均年龄68.2岁。UIA大小从2.7到26（平均：7.3）mm不等。研究的主要终点是使用改良的Rankin量表评估患者出院时的预后。我们使用磁共振成像检查了不良预后和脑白质损伤的危险因素。结果23例（10.7%）患者预后良好。单因素回归分析发现，不良预后与UIA大小（P< 0.0001）、UIA位于后方（P= 0.0204）、UIA血栓形成（P= 0.0002）和wml存在（P< 0.0001）之间存在显著相关。然而，不良预后与年龄之间没有显著相关性（P= 0.1438）。多因素logistic回归分析显示，不良预后与UIA大小（P< 0.0001）、wml的存在（P= 0.001）有显著相关性。基于Fazekas分级的严重脑损伤与年龄（P< 0.0001）和动脉粥样硬化（P= 0.0001）相关。重度脑损伤与缺血（P< 0.001）、癫痫（P= 0.0502）及住院时间（P< 0.0001）相关。结论严重脑白质损伤是老年人尿路感染手术治疗的危险因素。在处理严重脑白质损伤患者时，必须考虑手术指征并采取谨慎措施。
IntroductionWe aimed to identify the risk factors for surgical treatment of unruptured intracranial aneurysms (UIAs) in individuals aged >60 years, particularly focusing on white matter lesions (WMLs).Material and methodsWe investigated a total of 214 patients with UIAs. The patient group comprised 53 males and 151 females with an average age of 68.2 years. UIA size ranged from 2.7 to 26 (mean: 7.3) mm. The primary endpoint of the study was patient prognosis evaluated at the time of discharge using the modified Rankin Scale. We examined the risk factors for poor outcome and WMLs using magnetic resonance imaging.ResultsPoor outcome was observed in 23 (10.7%) patients. Significant correlations were observed between poor outcome and UIA size (P< 0.0001), UIAs located posteriorly (P= 0.0204), UIA thrombosis (P= 0.0002), and presence of WMLs (P< 0.0001) in univariate regression analysis. However, no significant correlations were noted between poor outcome and age (P= 0.1438). Multivariate logistic regression analyses showed significant correlations between poor outcome and UIA size (P< 0.0001), presence of WMLs (P= 0.001). Severe WMLs based on the Fazekas classification was correlated to age (P< 0.0001) and atherosclerosis (P= 0.0001). Severe WMLs were associated with ischemia (P< 0.001) and epilepsy (P= 0.0502) as well as length of hospitalization (P< 0.0001).ConclusionSevere WMLs are risk factors for surgical treatment of UIAs in the elderly. Surgical indications must be considered and caution should be taken when managing patients with severe WMLs.