Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Alterations of vital signs as prognostic factors after intraprocedural rupture of intracranial aneurysms during endovascular treatment

  • Keonhee Kim (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Junhyung Kim (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sang Kyu Park (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Keun Young, Park (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Joonho Chung (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2022.05.05
  • Accepted : 2022.08.20
  • Published : 2023.06.30
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Abstract

Objective: To report our experience with intraprocedural rupture (IPR) of intracranial aneurysms during endovascular treatment and evaluate alterations in vital signs as independent prognostic factors to predict the outcomes of IPR. Methods: Between January 2008 and August 2021, 34 patients (8 ruptured and 26 unruptured) were confirmed to have IPR based on our dataset with 3178 endovascular coiling procedures. The patients who underwent additional surgeries related to IPR were classified as the OP group (n=9), while those who did not receive additional surgeries were classified as the non-OP group (n=25). Vital signs were recorded during the procedure by anesthesiologists and analyzed. Results: Of the 34 patients included in this study, eight initially presented with subarachnoid hemorrhage due to a ruptured aneurysm. The clinical outcomes at discharge were significantly different between the two groups (p=0.046). In the OP group, five patients showed favorable outcomes at discharge, while four showed unfavorable outcomes. In the non-OP group, 23 patients showed favorable outcomes at discharge while two patients showed unfavorable outcomes. Maximal (MAX) systolic blood pressure (SBP) (odds ratio [OR] 1.520, 95% confidence interval [CI] 1.084-2.110; p=0.037) and higher differential value MAX-median blood pressure (MBP) (OR 1.322, 95% CI 1.029-1.607; p=0.044) remained independent risk factors for poor prognosis after IPR on multivariate logistic regression analysis. Conclusions: The MAX SBP and the difference between the maximal and baseline values of MBP are key factors in predicting the prognosis of patients after IPR, as well as providing useful information for predicting the outcome. Further research is required to confirm the relationship between naive pressure and prognosis.

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References

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