Analysis of the efficacy and factors affecting the prognosis of intracranial dissecting aneurysm treated with multi-stent overlap technique

Abstract Objective: The study aims to identify characteristics that impact the postoperative prognosis and recurrence of intracranial dissecting aneurysms (IDA) patients treated using multi-stent overlapping techniques. Methods:Clinical data from 69 IDA patients treated with multistate-assisted spring coil embolization at the Hospital between January 2017 and October 2023 were retrospectively reviewed, including clinical and imaging data gathered at admission and discharge. Patients were separated into two groups based on their prognosis at discharge: "good prognosis" and "wrong prognosis." They were split into two groups: recurrence and no-recurrence, based on whether the patients had recurrence during surgical follow-up. The patient's clinical information and aneurysm data were compared between the two groups to better understand the efficacy of multi-stenting for IDA and to investigate the factors that influence the good or negative prognosis of multi-stenting for IDA and recurrence. Results: Ten patients with multiple stents died, while 59 had a good prognosis. Hunt classification (c2=25.503a, P=<0.01), hospitalization days (t=-3.873, P<0.01), operation time (t=-1.970, P=0.049), and aneurysm height (t=-1.969, P=0.049) were all significant. Sixty-two patients were discharged with four postoperative recurrences and 58 without recurrences in patients treated with multiple stents, with significant differences in the largest diameter (t=-2.235, P=0.025), basal length (t=-2.149, P=0.032), and staging (c2=10.955a, P=0.001). The postoperative recurrence rate was 5.8%, but 85.8% reported satisfactory neurologic function (mRS < 2). The case fatality rate was 10.1%. Conclusion: Hunt-Hess grading on admission, hospitalization days, and operation time affect the prognosis of IDA. Aneurysm size, longest diameter, basal length, and location at the base of the pica affect recurrence. Involvement of the pica base by the dissecting aneurysm is an independent risk factor for recurrence.