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Predictors of postoperative cerebral ischemia in patients with ruptured anterior communicating artery aneurysms.
World Neurosurg. 2017 Apr 10;:
Authors: Yao PS, Chen GR, Zheng SF, Kang DZ
Abstract
OBJECTIVE: Cerebral ischeamia is a major contributor to poor outcome after ruptured anterior communicating artery aneurysms (AcoAs), and is not well classified. Here we develop a classification and identify risk factors of cerebral ischemia after ruptured ACoAs.
MATHERIAL AND METHODS: A total of 360 patients with ruptured ACoAs undergoing microsurgical clipping were collected. Sex, age, smoking, Hunt-Hess grade, Fisher grade, hospital stay, surgical timing, hypertension, diabetes, postoperative cerebral ischemia, and postoperative mRS score were collected. Postoperative ischemic changes are classified according to a novel grade (Ischemic Grade, Grade Ⅰ- Ⅳ).
RESULTS: Predictive factors of postoperative ischemia (Grade Ⅰ- Ⅳ) included sex (OR 1.956, 95% CI 1.262-3.032, p = 0.003) and Fisher grade (OR 1.813, 95% CI 1.144-2.871, p = 0.011). Male sex had a tendency to develop postoperative cerebral ischemia (61.3% in ischemia group vs 45.7% in non-ischemia group), while surgical timing not. However, in patients with postoperative ischemia, early surgery within 3 days (OR 3.334, 95% CI 1.411-7.879, p = 0.006) and advanced age over 55 years (OR 2.783, 95% CI 1.214-6.382, p = 0.016) were risk factors for postoperative neurological deficits (Grade Ⅲ-Ⅳ).
CONCLUSION: Male sex and higher Fisher grade predict postoperative ischemia (Grade Ⅰ- Ⅳ), while surgical timing not. However, in patients with postoperative cerebral ischemia, early surgery within 3 days and age over 55 years may increase the frequency of postoperative neurological deficits (Grade Ⅲ-Ⅳ). It seems male elderly patients undergoing early microsurgery had a tendency to develop neurological deficits.
PMID: 28408258 [PubMed - as supplied by publisher]
http://ift.tt/2pi4GpE
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