■术中破裂(IPR)是未破裂颅内动脉瘤(UIAs)的血管内弹簧圈栓塞的严重并发症。尽管知识产权审查后的结果很差,预防随后神经恶化的方法尚未得到研究.我们评估了知识产权的风险因素和管理策略,特别是球囊引导导管(BGC)在快速止血中的作用。
■我们回顾性回顾了2003年至2021年在三个机构接受线圈栓塞治疗的所有UIA病例,重点是术前放射学数据,操作细节,和结果。
■总共,2026例患者共治疗2172个动脉瘤。其中,19例患者中有19例动脉瘤(0.8%)在手术过程中破裂。多因素分析显示动脉瘤有气泡(OR:3.03,95%CI:1.21~7.57,p=0.017),颈部尺寸小(OR:0.56,95%CI:0.37至0.85,p=0.007),与没有PcomA的颈内动脉相比,后交通动脉(PcomA)(OR:4.92,95%CI:1.19至20.18,p=0.027)和前交通动脉(AcomA)(OR:12.08,95%CI:2.99至48.79,p<0.001)的动脉瘤与IPR显着相关。非BGC组和BGC组的IPR发生率相似(0.9%vs.0.8%,p=0.822);然而,利用BGC与IPR后较低的发病率和死亡率显着相关(0%vs.44%,p=0.033)。
■IPR的发生率相对较低。一个水泡,小动脉瘤颈,PcomA和AcomA的位置是IPR的独立危险因素。在IPR患者中使用BGC可以预防致命的临床恶化并获得更好的临床结果。
UNASSIGNED: Intraprocedural rupture (IPR) is a serious complication of endovascular coil embolization of unruptured intracranial aneurysms (UIAs). Although outcomes after IPR are poor, methods to prevent subsequent neurological deterioration have not yet been investigated. We evaluated the risk factors and management strategies for IPR, particularly the role of balloon guiding catheters (BGCs) in rapid hemostasis.
UNASSIGNED: We retrospectively reviewed all UIA cases treated with coil embolization at three institutions between 2003 and 2021, focusing on preoperative radiological data, operative details, and outcomes.
UNASSIGNED: In total, 2,172 aneurysms were treated in 2026 patients. Of these, 19 aneurysms in 19 patients (0.8%) ruptured during the procedure. Multivariate analysis revealed that aneurysms with a bleb (OR: 3.03, 95% CI: 1.21 to 7.57, p = 0.017), small neck size (OR: 0.56, 95% CI: 0.37 to 0.85, p = 0.007), and aneurysms in the posterior communicating artery (PcomA) (OR: 4.92, 95% CI: 1.19 to 20.18, p = 0.027) and anterior communicating artery (AcomA) (OR: 12.08, 95% CI: 2.99 to 48.79, p < 0.001) compared with the internal carotid artery without PcomA were significantly associated with IPR. The incidence of IPR was similar between the non-BGC and BGC groups (0.9% vs. 0.8%, p = 0.822); however, leveraging BGC was significantly associated with lower morbidity and mortality rates after IPR (0% vs. 44%, p = 0.033).
UNASSIGNED: The incidence of IPR was relatively low. A bleb, small aneurysm neck, and location on PcomA and AcomA are independent risk factors for IPR. The use of BGC may prevent fatal clinical deterioration and achieve better clinical outcomes in patients with IPR.