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  • Intracranial hematoma following ruptured anterior communicating artery aneurysms: risk factors, outcome, and prognostic factors after management of coiling first

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Hemorrhagic stroke
Original research
Intracranial hematoma following ruptured anterior communicating artery aneurysms: risk factors, outcome, and prognostic factors after management of coiling first
  1. Heng Ni,
  2. Lin-Bo Zhao,
  3. Sheng Liu,
  4. Zhen-Yu Jia,
  5. Yue-Zhou Cao,
  6. Hai-Bin Shi
  1. Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
  1. Correspondence to Dr Hai-Bin Shi, Department of Interventional Radiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China; shihb{at}njmu.edu.cn

Abstract

Background To determine the risk factors for intracranial hematoma (ICH) development following ruptured anterior communicating artery (AcomA) aneurysms and to determine prognostic factors associated with unfavorable outcomes after coiling first.

Methods From March 2014 to February 2020, 235 patients with ruptured AcomA aneurysms underwent endovascular treatment in our department. The clinical and radiographic conditions were collected retrospectively. Modified Rankin Scale (mRS) scores of ≤ 2 were accepted as favorable outcomes. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to the incidence of ICHs and to unfavorable outcomes.

Results Of these 235 patients, 68 had additional ICHs. A posterior orientation of ruptured AcomA aneurysms was the independent variable associated with the incidence of ICHs (OR 3.675; p<0.001). Furthermore, having preoperative Hunt–Hess grades Ⅳ–Ⅴ was an independent variable associated with unfavorable outcomes for ICH patients (OR 80.000; p<0.001). Among the 68 patients with ICHs, 40% (27/68) had Hunt–Hess grades IV–V. Four percent of patients (3/68) underwent surgical hematoma evacuation after the coiling procedure and 15% of the patients (10/68) underwent external ventricular drainage. A favorable outcome was achieved in 72% (49/68) of patients with ruptured AcomA aneurysms. The mortality rate was 21% (14/68) at 6 months.

Conclusion A posterior orientation of ruptured AcomA aneurysms was associated with the incidence of ICHs. Coiling first with surgical management if necessary seems to be an acceptable treatment for ruptured AcomA aneurysms with ICHs. The clinical outcome was associated with the clinical neurological status on admission.

  • aneurysm
  • coil
  • artery

Data availability statement

Data are available upon reasonable request. Individual patient data cannot be made available because we did not obtain patient approval for sharing individual patient data. However, all syntax files and output of statistical analyses will be made available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017506

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    Data availability statement

    Data are available upon reasonable request. Individual patient data cannot be made available because we did not obtain patient approval for sharing individual patient data. However, all syntax files and output of statistical analyses will be made available upon reasonable request.

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    Footnotes

    • HN and L-BZ contributed equally.

    • Contributors All authors contributed to the study conception and design. HN and LBZ analyzed the data and drafted the manuscript. SL, ZYJ, and YZC helped perform the analysis with constructive discussions. H-BS generated the conception, and gave final approval for the version to be submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.