Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome
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Cerebral infarction (CI) associated with clipping of unruptured intracranial aneurysms (UIAs) has not been completely studied. The role of individual and operative characteristics is not known, and the risk of silent CI has not been well described. To determine the incidence, risk factors, and clinical outcome of postoperative CI, we retrospectively analyzed 388 consecutive patients undergoing clipping of UIAs between January 2012 and December 2015. We reviewed the pre- and postoperative computed tomography (CT) images of each patient. Postoperative CI was defined as a new parenchymal hypodensity in the vascular territory of treated artery. Patient-specific, aneurysm-specific, and operative variables were analyzed as potential risk factors. Functional outcome at discharge was assessed with the modified Rankin Scale (mRS). Postoperative CI was found in 49 (12.6%) patients, 29 of whom manifested neurological deficits. The incidences of symptomatic stroke and silent CI were 7.5 and 5.2%, respectively. Multivariate analysis showed that larger aneurysm size and history of hypertension were significantly associated with CI. Disability (mRS > 2) rate was 42.9% among patients with CI, which was substantially higher than that among patients without (0.9%). In conclusion, the incidence of CI following clipping of UIAs was not low. Larger aneurysm size and history of hypertension were independent risk factors. Postoperative symptomatic stroke correlated with an extremely high risk of disability. Silent CI was seemingly nondisabling, but the possible cognitive consequence is pending.
KeywordsUnruptured intracranial aneurysm Surgery Cerebral infarction Computed tomography Risk factor
This study was supported by the projects of National Natural Science Foundation of China (Grant No. 81471210, principal investigator: Professor Shuo Wang). It was also supported by the project of Beijing Municipal Commission of Science and Technology (Grant No. D161100003816004, principal investigator: Professor Yong Cao).
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
This study has been approved by the ethics committee of Beijing Tiantan Hospital, Capital Medical University.
The need for written informed consent was waived, due to the retrospective nature of this study.
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