INTRODUCTION
The concept of «complex» aneurysm is now widely used in the planning of neurosurgical interventions. It is obvious that the definition and objectification of this concept should be separate for microsurgical and endovascular treatment.
OBJECTIVE
Is to objectify the «complex aneurysm» concept with regard to endovascular treatment.
MATERIAL AND METHODS
A total of 739 patients, who underwent endovascular treatment of the unruptured aneurysm in the NMRC of Neurosurgery named after Academician N. N Burdenko in the period from 01.01.2018 to 01.02.2022, were analyzed. We evaluated 8 anatomical and morphological characteristics (AMCs) of the aneurysm and presence of 2 pathologies of brachiocephalic arteries (BCAs). Statistical analysis of the treatment results, determination of the statistical significance of differences in complications incidence depending on the presence of studied AMCs of the aneurysm and BCAs pathology were performed. On the basis of this analysis, an index of the complexity of endovascular treatment of unruptured aneurysms (ICAe) was created and the significance of differences in the incidence of complications according to the value of ICAe was evaluated. Web application for ICAe calculation — www.isae.rf — was created.
RESULTS
The proportion of patients with pronounced neurological deficit on the day of discharge amounted to 0.8%, the incidence of death — 0.1% (1 patient). New neurological deficit after the surgery occurred in 4.6% of cases, moderate and severe complications — in 3.2% of cases. Non-radical aneurysm exclusion after 12 months was observed in 22.1% of cases.
At ICAe=0, the incidence of complications was lower in the general group by 0.9 — 10.9%. The ICAe value of 1 score was intermediate (part of complications occurred more often, part less). The incidence of adverse outcomes and complications was increased by 1.8—18.5% for ICAe=2, by 0.8—27.9% for ICAe=3 and by 6.5—28.7% for ICAe=4—5.
CONCLUSION
The created ICAe allows to objectively distinguish a group of aneurysms complex for endovascular treatment, stratify aneurysm complexity and incidence of adverse outcomes and complications.
Aneurysms with ICAe³2 can be classified as «complex» for endovascular treatment.
