Artikel
Risk factors for aneurysm remnants after microsurgical clipping determined by morphometric analysis and proposal of a risk sum score
Risikofaktoren für unvollständigen Aneurysma-Verschluss nach Clipping auf der Basis einer morphometrischen Analyse und Vorschlag eines Risiko-Scores
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Autoren
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Lukas Goertz
- Universitätsklinikum Köln, Köln, Deutschland
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Muriel Pflaeging
- Universitätsklinikum Köln, Köln, Deutschland
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Christoph Kabbasch
- Universitätsklinikum Köln, Köln, Deutschland
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Gerrit Brinker
- Universitätsklinikum Köln, Köln, Deutschland
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Roland H. Goldbrunner
- Universitätsklinikum Köln, Köln, Deutschland
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Boris Krischek
- Universitätsklinikum Köln, Köln, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Microsurgical clipping provides more durable aneurysm occlusion than endovascular therapy. Albeit the risk of aneurysm remnants after microsurgical clipping is relatively low, complete aneurysm occlusion cannot always be guaranteed. Some aneurysms with incomplete clip occlusion may carry a residual rupture risk and may therefore require retreatment. The objective was to perform a morphometric analysis of intracranial aneurysms to identify predictors for aneurysm remnants and to propose a novel risk score.
Methods: This is a retrospective, single-center analysis of consecutive patients with ruptured and unruptured aneurysms that underwent microsurgical clipping and postoperative digital subtraction angiography between 2010 and 2018. Based on preoperative rotational angiography, distinct morphological aneurysm characteristics (e.g. ruptured status, location, size, neck width, aneurysm and vessel geometry) were determined and correlated with postoperative angiographic results. Factors predictive in the univariate and multivariate analyses were weighted to establish a risk sum score for postoperative remnants after aneurysm clipping. Performance of the score was evaluated by receiver operating characteristic analysis.
Results: A total of 140 patients with 166 clipped aneurysms were included. Postoperative angiography revealed aneurysm remnants in 19.9%. In the multivariate analysis, ruptured aneurysm status (OR: 7.8, 95% CI: 1.7 – 36; p<0.01) and increased aspect ratio (OR: 1.9, 95% CI: 1.0 – 4.0; p=0.07) were associated with postoperative aneurysm remnants. Anterior communicating artery location (p=0.02), internal carotid artery location (p=0.06), increased aneurysm inclination angle (p<0.01) and irregular aneurysm shape (p=0.07) were further predictors for aneurysm remnants in the univariate analysis. These factors were weighted and included into a risk sum score for postoperative aneurysm remnants (range: 0 – 8 points), which performed with good accuracy in the same cohort (AUC = 0.807).
Conclusion: After external validation of the proposed risk score, it could help identify cases requiring angiographic control after aneurysm surgery.
