Risk factor analysis for ischemic stroke after stent-assisted treatment of cerebral aneurysms

Cerebral aneurysms, if untreated, can lead to fatal intracranial hemorrhages. Stent-assisted treatment offers a less invasive management approach but is associated with the risk of ischemic stroke. This study identifies risk factors for MRI-diagnosed ischemic stroke following stent-assisted cerebral aneurysm treatment.

A multicenter retrospective study was conducted on 186 patients who underwent stent-assisted treatment for cerebral aneurysms at two institutions from January 2021 to December 2024. Patients were divided into two groups: occurrence (15 experienced ischemic stroke) and non-occurrence (171 no ischemic stroke). The overall rate of MRI-diagnosed ischemic stroke (presence of new diffusion-weighted imaging lesions) was 8.1% (15/186). Data on demographic, clinical, hemodynamic, laboratory, and stent characteristics were collected. Uni-/multivariate logistic regression and correlation analyses were performed to determine significant risk factors.

The occurrence group was characterized by a significantly higher BMI (P = 0.007), hypertension prevalence (P = 0.007), elevated arterial stiffness index (ASI) (P = 0.003), and higher platelet counts (P = 0.004). Positive rates for ACA IgG and anti-β2GPI IgG antibodies were significantly higher in the occurrence group (P = 0.015 and P = 0.003, respectively). Poor adherence to antiplatelet therapy (P = 0.003) and high-risk alcohol consumption (P = 0.005) correlated with increased stroke risk. Logistic regression identified higher BMI, hypertension, ASI, and specific autoantibodies as significant risk factors. Conversely, adherence to antiplatelet therapy significantly reduced stroke risk (P = 0.038).

The study highlights multiple risk factors for ischemic stroke following stent-assisted treatment of cerebral aneurysms, including elevated BMI, hypertension, arterial stiffness, and specific antibody presence.