Risk Factors for Cerebral Infarction After Microsurgical Clipping of Hunt-Hess Grade 0–2 Single Intracranial Aneurysm: A Retrospective Study

• Published in: World neurosurgery 2023-03, Vol.171, p.e186-e194
• Main Authors: Yang, Yibing, He, Kejun, Liu, Linfeng, Li, Fanying, Zhang, Guofeng, Xie, Baoshu, Liang, Feng
• Format: Article
• Language: English
• Subjects: Aneurysm, Ruptured - surgery; Cerebral infarction; Cerebral Infarction - etiology; Humans; Hunt-Hess scale; Intracranial aneurysm; Intracranial Aneurysm - surgery; Ischemic Attack, Transient; Microsurgical clipping; Retrospective Studies; Risk Factors; Stroke - complications; Subarachnoid hemorrhage; Treatment Outcome
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2022.11.124

The study aimed to explore risk factors for cerebral infarction after microsurgical clipping in patients with Hunt-Hess grade 0–2 single intracranial aneurysms. A total of 137 patients with Hunt-Hess grade 0–2 single intracranial aneurysms treated with microsurgical clipping between March 2017 and December 2020 were retrospectively enrolled. Patients were divided into 2 groups on the basis of the occurrence of cerebral infarction after surgery. Of 137 enrolled patients, 14 (10.22%) showed cerebral infarction symptoms after surgery. Univariate analysis indicated that ruptured aneurysm status, aneurysm rupture during surgery, history of transient ischemic attack (TIA)/stroke, aneurysm size ≥7 mm, temporary clipping, intraoperative systolic hypotension (IOH), and occurrences of intraoperative motor-evoked potentials change were significantly related to postoperative cerebral infarction (PCI). However, using multivariate regression, only history of TIA/stroke (odds ratio = 0.124; 95% confidence interval [CI] = 0.021–0.748, P = 0.023) and IOH (odds ratio = 0.032; 95% CI = 0.005–0.210, P < 0.001) were independent predictors for PCI. Receiver operating characteristic curve analysis showed that the critical duration of temporary clipping and IOH that minimized the risk of PCI was 5.5 minutes and 7.5 minutes, respectively. Our study identified history of TIA/stroke and IOH as independent risk factors for cerebral infarction after microsurgical clipping.