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Clinical features of ischemic complications after unruptured middle cerebral artery aneurysm clipping: patients and radiologically related factors

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Abstract

Postoperative ischemic complication results in neurological sequelae and longer hospitalization after unruptured middle cerebral artery (MCA) aneurysm clipping surgery. We evaluated the radiological and patient-related factors associated with ischemic complications after unruptured MCA aneurysm clipping surgery. Patient demographics, radiological findings, and intraoperative factors were compared between patients with and without postoperative ischemic complications. The clinical courses and outcomes of postoperative ischemic complications were compared according to the types of ischemic complication. Forty-two out of 2227 patients (1.9%) developed postoperative ischemic complications after MCA aneurysm clipping. Multivariate analysis revealed that diabetes mellitus (DM) was a patient-related factor. Intraarterial (IA) calcification of the distal internal carotid artery (ICA), preoperative M1 stenosis, and M1 aneurysm were radiological factors that increased the risk of postoperative ischemic complications. DM was significantly associated with divisional branch territory infarction (P = 0.04). The time to first presentation of ischemic complication was significantly longer in divisional branch territory infarction than perforator territory infarction (67.8 ± 75.9 h vs. 22 ± 20.7, P = 0.023). Twelve out of 42 patients with ischemic complications (28.6%) had unfavorable outcome (mRS > 3). Perforator territory infarction was significantly associated with an unfavorable outcome (mRS > 3, P = 0.019). IA calcification of the distal ICA, M1 stenosis and aneurysms, and DM were significantly associated with postoperative ischemic complications after unruptured MCA aneurysm clipping. Patients with DM should be closely monitored postoperatively to detect delayed occurrence of divisional branch infarction. Trial registration number: 2019-1002, Date of registration: January 1, 2005, “retrospectively registered”

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Acknowledgment

The authors are thankful to all staff members of neurosurgical department and the patients of the study group whose contributions made this work possible.

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Authors and Affiliations

  1. Department of Neurosurgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea

    Heui Seung Lee

  2. Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Moinay Kim, Jung Cheol Park, Jae Sung Ahn, Seungjoo Lee & Wonhyoung Park

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Contributions

Heui Seung Lee M.D. (first author) conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, and wrote the paper, and other contribution. Moinay Kim M.D conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, and thoroughly reviewed the manuscript and made corrections. Jung Cheol Park M.D conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, and thoroughly reviewed the manuscript and made corrections. Jae Sung Ahn, M.D, Ph.D conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, and other contribution. Seungjoo Lee, M.D, Ph.D conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, and other contribution. Wonhyoung Park, M.D., Ph.D. (corresponding author) conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, and thoroughly reviewed the manuscript and made corrections.

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Correspondence to Wonhyoung Park.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of retrospective study, formal consent is not required.

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SPSS version 22.0 (IBM, Armonk, NY, USA) was used for all statistical analyses

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Lee, H.S., Kim, M., Park, J.C. et al. Clinical features of ischemic complications after unruptured middle cerebral artery aneurysm clipping: patients and radiologically related factors. Neurosurg Rev 44, 2819–2829 (2021). https://doi.org/10.1007/s10143-021-01475-8

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