Predictive Factors of Cerebral Aneurysm Rerupture After Clipping

Yu-Jun Chang; Chi-Kuang Liu; Chun-Yuan Cheng; Yu-Cheng Shih; Shih-Chun Wang; Chung-Chih Lin; Chih-Ming Lin

doi:10.3389/fneur.2021.789216

Predictive Factors of Cerebral Aneurysm Rerupture After Clipping

Front Neurol. 2022 Feb 16:12:789216. doi: 10.3389/fneur.2021.789216. eCollection 2021.

Authors

Yu-Jun Chang¹, Chi-Kuang Liu², Chun-Yuan Cheng^{3

4}, Yu-Cheng Shih⁵, Shih-Chun Wang², Chung-Chih Lin⁶, Chih-Ming Lin^{4

5

7}

Affiliations

¹ Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan.
² Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
³ Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁵ Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
⁶ Department of Research, Changhua Christian Hospital, Changhua, Taiwan.
⁷ Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan.

Abstract

Background: We aimed to estimate the risk of rerupture after first-time aneurysmal clipping surgery, explore the possible related factors, and assess long-term physical functionality. We hypothesized that the modified Rankin scale (mRS) could serve as an effective substitute for Hunter and Hess scale.

Methods: This retrospective study included 171 patients with cerebral aneurysmal rupture who had completed aneurysmal clipping treatment and collected their demographic data and medical records. The outcome assessments include neuroimaging records, Hunter and Hess scale, and the mRS scale during hospitalization and follow-up after discharge. The mean length of follow-up was 4.28 years.

Results: After aneurysmal clipping treatment, 83 patients (48.5%) had subsequently ruptured aneurysms. The scores of the reruptured group on the Hunt and Hess scale and mRS were significantly higher than those of the non-reruptured group. Multiple Cox proportional-hazards regression also showed that postoperative mRS >2, smoking, and two or more aneurysms were potentially important risk factors leading to aneurysm rupture again [the corresponding hazard ratios (HRs) were 5.209, 2.109, and 2.775, respectively] in patients. In addition, the location of an aneurysm on the anterior cerebral artery (ACA) or the posterior communicating (Pcom) artery had a higher risk of rerupture (the corresponding HRs were 1.996 and 2.934, respectively).

Conclusions: Nearly half of the collected participants experienced the rerupture episode, who had undergone the second-time clipping surgery. Smoking and multiple aneurysms are potential risk factors for aneurysmal rerupture. Most aneurysms are located along the ICA, but aneurysms located at the ACA or Pcom site are most likely to rerupture. As compared with the Hunter and Hess scale, the mRS scale does not have inferior predicting power in following patients' long-term functionalities.

Keywords: aneurysm location; aneurysmal clipping treatment; aneurysmal rerupture; cerebral aneurysm; incidence.