Risk factors for surgery-related cerebral infarction after aneurysmal subarachnoid hemorrhage

Surgery-related cerebral infarction (SRCI) is an important complication after aneurysmal subarachnoid hemorrhage (aSAH), and detailed assessment of the characteristics and risk of SRCI is insufficient. We aimed to analyze the risk factors for SRCI in different treatment modalities after aSAH. A total of 472 patients were included in this retrospective study, including 169 in clip and 303 in endovascular. Regarding radiologically observable SRCI as the outcome, we used univariate and multivariate statistical analyses of risk factors and summarized the characteristics of SRCI. The incidence of SRCI was significantly higher in the clipping group compared to the endovascular group (47% vs. 21%, p < 0.001). Patients with SRCI in clip group had higher HH (p = 0.007) and mFisher (p = 0.007) and more diabetics (p = 0.018). They were more likely to receive primary EVD (p < 0.001), decompressive craniectomy (p = 0.022), multiple aneurysms repair (p = 0.008), and had longer procedure time (p = 0.006). Patients with SRCI in endovascular group were older (p = 0.001), more hypertensive (p = 0.001), with higher HH (p = 0.034) and longer procedure time (p = 0.005). They were more likely to presented with acute hydrocephalus (p = 0.030), type-3 aortic arch in pathway (p = 0.009) and proximal stenosis of the parent artery (p = 0.045). Multivariate regression analysis identified diabetes (OR = 7.050, 95%CI: 1.303-38.158), primary EVD (OR = 4.066, 95%CI: 1.567-10.550), longer procedure time (OR = 1.007, 95%CI: 1.001-1.013), and repair multiple aneurysms (OR = 3.916, 95%CI: 1.142-13.432) independently predicted SRCI in clip group. Age (OR = 1.033, 95%CI: 1.001-1.066), hypertension (OR = 2.337, 95%CI: 1.220-4.478), type-3 aortic arch in pathway (OR = 4.010, 95%CI: 1.177-13.666), and proximal stenosis of parent artery (OR = 2.442, 95%CI: 1.015-5.875) independently predicted SRCI in endovascular group. Diabetes, primary EVD, longer procedure time, and repair multiple aneurysms were independent risk factors for SRCI in clip group. In contrast, age, hypertension, type-3 aortic arch in pathway, and proximal stenosis of parent artery were independent risk factors for SRCI in endovascular group.