Epidemiological analysis of patients with cerebral aneurysms submitted to embolization at São José do Avaí Hospital

Introduction

Cerebral aneurysms affect between 1 and 5% of the adult population and are responsible for significant rates of morbidity and mortality. The treatment of intracranial aneurysms evolved substantially since the introduction of endovascular neurosurgery by Guglielmi detachable coils (GDC) in the 1990s. The ablation overtook a clipping as the initial method in many centers, including Brazil, because of the safety and feasibility of this method.

Methods

This cohort retrospective study analyses clinical and epidemiological variables. It was conducted from the database of patients submitted to ablation in the neurosurgery department of São José do Avaí Hospital in the period of December 2006 to November 2009.

Results

We studied 1,504 patients submitted to ablation. There 1,120 were females (74.46%) and 384 males. The average age was 52 years. Hunt-Hess scale prevalence: 1 - 67.88%, 2 - 18.62%, 3 - 8.19, 4 - 4.92%, 5 - 2.32%, and Fisher: 1 - 62.58%, 2 - 7.91%, 3 - 17.08%, 4 - 7.58%. The main risk factors involved in the cerebral vascular accident were: systemic arterial hypertension 40.4% (n = 608) and smoking 30.8% (n = 463). The arteries more involved were: posterior communicant = 381 (25.33%), median cerebral = 296 (19.61%) and anterior communicant = 254 (16.87%). A total 72.67% of patients presented only one aneurysm (n = 1,093) and 27.33% two or more aneurysms (n = 411). We observed an occurrence of 1,217 (80.91%) ruptured aneurysms and 287 incidental. The sizes of the aneurysms were: 46.30% standard aneurysms (between 5 and 25 mm), 47.95% smaller than 5 mm and 5.75% giant. The aneurysms were narrow neck in 37.78% of the cases (n = 1,082), and large in 14.34% (n = 412). Among the 218 events that occurred, there were coils into the vascular lumen in 96 cases (6.38%), bleeding in 58 (3.85%) and others. The materials used were: 334 balloons and 136 stents. Angiographic vasospasm occurred in 178 patients.

Conclusions

There was a predominance of females for the occurrence of cerebral vascular aneurysmatic accident. The average age was 52 years. Systemic hypertension and smoking showed strong association with the rupture of intracranial aneurysms. The arteries of the previous segment were those that had higher incidence of aneurysms. More than one-half of the patients did not have complications during the procedure. Embolization of cerebral aneurysms was revealed to be a low lethality method.