Differences of efficacy and the incidence of DCI between early and delayed interventional therapy in patients with intracranial ruptured aneurysms

Abstract

Objective To investigate the differences of efficacy and the incidence of delayed cerebral ischemia (DCI) between early and delayed interventional therapy in patients with intracranial ruptured aneurysms, and the risk factors leading to postoperative DCI. Methods The clinical data of 98 patients with intracranial ruptured aneurysm who underwent interventional therapy in our hospital from January 2014 to February 2018 were retrospectively analyzed. The patients were divided into early group (n=57) and delayed group (n=41) according to the timing of interventional surgery. All of the patients underwent interventional therapy based on conventional therapy. The early intervention time was within 72 h after the onset, while the delayed intervention time was more than 72 h after the onset. The differences in treatment outcomes, postoperative complications, and prognosis between the two groups were compared, and the multivariate logistic analyses were performed on the risk factors for postoperative DCI. Results There was no significant difference in the NIHSS scores between the two groups at 7 d after treatment (6.27±2.19 vs 5.76±1.94, P>0.05). The complete embolization rate was significantly higher in the early group than in the delayed group (91.23% vs 73.17%, P 0.05). The prognosis rate and Barthel index score were significantly higher in the early group at 3 months than in the delayed group (80.70% vs 70.73%, 63.51±13.42 vs 52.78±12.65, P<0.05). The incidence of DCI after treatment in this study was 12.44%. Hypoproteinemia, Fisher grade (Ⅲ-Ⅳ), and WFNS grade (Ⅲ-Ⅴ) were independent risk factors for DCI (OR=4.29, 5.48, 8.074, all P<0.05). Conclusion Interventional therapy is relatively effective in the treatment of patients with intracranial ruptured aneurysms, but early intervention can improve the embolization effect and improve the prognosis of patients, but the effect of postoperative DCI is not significant, leading to postoperative DCI. Hypoproteinemia, Fisher classification (Ⅲ-Ⅳ) and WFNS grade (Ⅲ-Ⅴ) are independent risk factors. Key words: Intracranial aneurysm; Interventional therapy; Timing of treatment; Delayed cerebral ischemia