Multifactorial Assessment of Complication Risks in Embolization for Ruptured Cerebral Aneurysm

Area of Science:

• Neuroendovascular therapy
• Cerebral aneurysms
• Neurosurgery

Background:

• Complications in neuroendovascular therapy for cerebral aneurysms (ANs) significantly impact patient outcomes.
• Risk factors include patient conditions, procedural details, and operator expertise, often interacting to increase risk.
• A multifactorial approach is needed to accurately assess these complex risks.

Purpose of the Study:

• To perform a multifactorial assessment of complication risks in neuroendovascular therapy for cerebral aneurysms.
• To identify specific high-risk situations arising from the combination of patient, procedural, and operator factors.
• To evaluate the impact of supervising physician presence on complication rates.

Main Methods:

• Analysis of data from the Japanese Registry of NeuroEndovascular Therapy 3 (2010-2014).
• Inclusion of patients undergoing coil embolization for ruptured anterior communicating artery (Acom), internal carotid artery-posterior communicating artery (IC-PC), or basilar artery bifurcation (BA-bif) ANs.
• Identification of specific high-risk situations using a programmed method considering 16 explanatory variables.

Main Results:

• A total of 2971 patients were analyzed with complication rates of 12.9% (Acom AN), 10.2% (IC-PC AN), and 13.7% (BA-bif AN).
• Fifteen specific high-risk situations were identified, with complication rates varying by AN location (e.g., 20.6%–33.3% for BA-bif ANs).
• Absence of a supervising physician significantly increased complication rates in four identified situations.

Conclusions:

• Multifactorial assessment incorporating patient, procedural, and operator factors yields more reliable risk estimations.
• Identifying specific high-risk scenarios aids in optimizing neuroendovascular procedures.
• Improving risk assessment strategies can lead to better clinical outcomes for patients with cerebral aneurysms.