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Predictors of Outcomes and Complications After Microsurgical and Endovascular Treatment of 1300 Intracranial Aneurysms.

Abstract：

BACKGROUND:We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise. METHODS:From January 2005 to December 2011, 1297 consecutive patients presenting with ruptured (n=829) or unruptured (n=468) aneurysms were prospectively enrolled in our vascular database. The treatment modality was determined by consensus of the endovascular and microsurgical teams. The patients' medical and neurological conditions and aneurysm characteristics were compared against the postintervention complication rates and outcomes using multivariate analyses. RESULTS:The patients mostly underwent clipping for ruptured (63.7%) or unruptured (56.6%) aneurysms. For ruptured aneurysms, higher Hunt and Hess and Fisher grades on admission were key predictors of increased neurological (P < 0.001 and P < 0.001, respectively) and medical (P < 0.001 and P=0.041, respectively) complication rates. No significant differences in the outcomes were observed between the coiling or clipping groups during the follow-up period. For the unruptured group, a family history of intracranial aneurysms was the most relevant predictor for reducing neurological complication rates and increasing survival at 6 months. Hypertension was, however, the strongest factor associated with complications negatively affecting the outcomes. CONCLUSIONS:For the ruptured and unruptured groups both, the outcomes were generally good, although neurological and medical complications were reasonably more frequent for the ruptured aneurysms. Coiling provided a sustained benefit in lowering the complication rates only in the short term for the unruptured aneurysms. Smoking was associated, paradoxically, with improved outcomes.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Acioly MA,Shaikh KA,White IK,Ziemba-Davis M,Bohnstedt BN,Cohen-Gadol A

doi

10.1016/j.wneu.2018.10.094

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

e516-e529

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32392-1

journal_volume

122

pub_type

杂志文章

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Predictors of Outcomes and Complications After Microsurgical and Endovascular Treatment of 1300 Intracranial Aneurysms.