Major intraoperative aneurysm rupture may increase the risk of cerebral infarction following surgical clipping of unruptured intracranial aneurysms

Abstract

ObjectiveIntraoperative aneurysm rupture (IAR) could cause a poor outcome. This study aimed to investigate the relationship between IARs and postoperative cerebral infarctions (CIs). MethodWe retrospectively reviewed patients with asymptomatic unruptured intracranial aneurysms (UIAs) who received microsurgical clipping in two neurosurgical centers from January 2016 to June 2019. A propensity score matching was done to constitute a cohort. The data were collected regarding the clinical and radiological characteristics. The CI at 1–2 weeks and the functional outcome at two weeks after clipping were recorded. Differences between IAR patients with CIs and without CIs were compared. The relationship between the IARs and postoperative CIs was investigated by using logistic regression analysis. ResultsThis study yielded 96 UIAs patients, including 48 patients undergoing IARs and 48 patients not. Twenty patients with CIs at 1–2 weeks after clipping were identified. The rate of CIs in patients undergoing IARs was higher than that in patients not undergoing IARs (OR, 2.88; p = 0.038); moreover, the mRS was also worse in patients undergoing IARs (OR, 1.58; p = 0.015). For patients undergoing IARs, the significance was found in ischemic cerebrovascular disease (OR, 6.40; p = 0.048), Essen stroke risk score (OR, 2.14; p = 0.026), and severity of intraoperative rupture (OR, 5.63; p = 0.023). The multivariate logistic analysis demonstrated the major IARs (OR, 6.09; CI, 1.18–31.53; p = 0.031) as the independent risk factor related to postoperative CI. ConclusionIARs could increase the risk of postoperative CIs and worsen the functional outcome, and major IAR was the independent risk factor related to the postoperative CIs.