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Clinical features of ischemic complications after unruptured middle cerebral artery aneurysm clipping: patients and radiologically related factors

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Abstract
Postoperative ischemic complication results in neurological sequelae and longer hospitalization after unruptured middle cerebral artery (MCA) aneurysm clipping surgery. We evaluated the radiological and patient-related factors associated with ischemic complications after unruptured MCA aneurysm clipping surgery. Patient demographics, radiological findings, and intraoperative factors were compared between patients with and without postoperative ischemic complications. The clinical courses and outcomes of postoperative ischemic complications were compared according to the types of ischemic complication. Forty-two out of 2227 patients (1.9%) developed postoperative ischemic complications after MCA aneurysm clipping. Multivariate analysis revealed that diabetes mellitus (DM) was a patient-related factor. Intraarterial (IA) calcification of the distal internal carotid artery (ICA), preoperative M1 stenosis, and M1 aneurysm were radiological factors that increased the risk of postoperative ischemic complications. DM was significantly associated with divisional branch territory infarction (P = 0.04). The time to first presentation of ischemic complication was significantly longer in divisional branch territory infarction than perforator territory infarction (67.8 +/- 75.9 h vs. 22 +/- 20.7, P = 0.023). Twelve out of 42 patients with ischemic complications (28.6%) had unfavorable outcome (mRS > 3). Perforator territory infarction was significantly associated with an unfavorable outcome (mRS > 3, P = 0.019). IA calcification of the distal ICA, M1 stenosis and aneurysms, and DM were significantly associated with postoperative ischemic complications after unruptured MCA aneurysm clipping. Patients with DM should be closely monitored postoperatively to detect delayed occurrence of divisional branch infarction. Trial registration number: 2019-1002, Date of registration: January 1, 2005, "retrospectively registered"
Author(s)
이희승김모이네박중철안재성이승주박원형
Issued Date
2021
Type
Article
Keyword
AneurysmClippingDiabetes mellitusInfarctionMiddle cerebral artery
DOI
10.1007/s10143-021-01475-8
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7634
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2479043164&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Clinical%20features%20of%20ischemic%20complications%20after%20unruptured%20middle%20cerebral%20artery%20aneurysm%20clipping:%20patients%20and%20radiologically%20related%20factors&offset=0&pcAvailability=true
Publisher
NEUROSURGICAL REVIEW
Location
미국
Language
한국어
ISSN
0344-5607
Citation Volume
44
Citation Number
5
Citation Start Page
2819
Citation End Page
2829
Appears in Collections:
Medicine > Medicine
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