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. 2025 Nov 3;48(1):754.
doi: 10.1007/s10143-025-03911-5.

Risk factors and the role of intraoperative hypotension in cerebral infarction after microsurgical clipping of intracranial aneurysms: a retrospective case-control study

Baoxuan Chen #  1 , Xu Zhao #  2 , Lingqi Gao #  1 , Wuya Huang  1 , Jiazheng Qi  1 , Zhoujing Yang  1 , Lingjing Zhang  1 , Fan Xiao  1 , Xiaoyu Yang  1 , Mengqiang Luo  3 , Yingwei Wang  4
Affiliations

Risk factors and the role of intraoperative hypotension in cerebral infarction after microsurgical clipping of intracranial aneurysms: a retrospective case-control study

Baoxuan Chen et al. Neurosurg Rev. .

Abstract

Blood pressure control during microsurgical clipping of intracranial aneurysms is challenging, as high blood pressure increases the risk of rupture, while hypotension may impair cerebral perfusion. The impact of intraoperative hypotension on postoperative cerebral infarction remains unclear. This study aims to identify independent risk factors and quantify the association between intraoperative hypotension and postoperative cerebral infarction. We conducted a retrospective case-control study of patients undergoing intracranial aneurysm clipping. The primary outcome was postoperative cerebral infarction, identified using routine computed tomography scans. Multivariate logistic regression analysis was performed to determine independent risk factors and assess the relationship between intraoperative hypotension parameters and postoperative cerebral infarction. Restricted cubic spline (RCS) models were used to quantify the relationship between intraoperative blood pressure and postoperative cerebral infarction. Among 689 patients, 83 (12.05%) experienced postoperative cerebral infarction. Multivariate regression analysis identified aneurysm size (odds ratio [OR] = 2.353, 95%CI: 1.327-4.173, P = 0.003), duration of intraoperative hypotension (OR = 1.021, 95%CI: 1.001-1.042, P = 0.045), and maximum diastolic blood pressure (OR = 0.717, 95%CI: 0.525-0.981, P = 0.038) as significant risk factors for postoperative cerebral infarction. RCS plots demonstrated an increased risk of postoperative cerebral infarction with prolonged hypotension durations and greater cumulative exposure to hypotension. The high incidence of cerebral infarction following intracranial aneurysm clipping underscores the need for careful perioperative management. Aneurysm size and intraoperative hypotension burden are independent risk factors for cerebral infarction. Strategies to minimize intraoperative hypotension during microsurgical clipping may help reduce postoperative infarction rates and improve patient outcomes. Clinical trial number: Not applicable.

Keywords: Intracranial aneurysm; Intraoperative hypotension; Microsurgical clipping; Postoperative cerebral infarction; Risk factors.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Huashan Hospital, Fudan University. The hospital’s ethics committee approved this study (KY2022-1091, November 18, 2022) and waived the requirement for informed consent. Informed consent: The submitted materials contained no personally identifiable information. The study was granted an exemption from requiring informed consent. Conflicts of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Competing interests: The authors declare no competing interests.

References

    1. Aso K, Kashimura H, Matsumoto Y et al (2018) Microsurgical clipping for anterior communicating artery aneurysm associated with the accessory anterior cerebral artery via the pterional approach. Surg Neurol Int 9(1):120. https://doi.org/10.4103/sni.sni_103_18 - DOI - PubMed - PMC
    1. Li M, Wu J, Chen X et al (2018) Symptomatic and silent cerebral infarction following surgical clipping of unruptured intracranial aneurysms: incidence, risk factors, and clinical outcome. Neurosurg Rev 41:675–682. https://doi.org/10.1007/s10143-017-0913-1 - DOI - PubMed
    1. Byoun HS, Bang JS, Oh CW et al (2016) The incidence of and risk factors for ischemic complications after microsurgical clipping of unruptured middle cerebral artery aneurysms and the efficacy of intraoperative monitoring of somatosensory evoked potentials: a retrospective study. Clin Neurol Neurosurg 151:128–135. https://doi.org/10.1016/j.clineuro.2016.10.008 - DOI - PubMed
    1. Kunz M, Bakhshai Y, Zausinger S et al (2013) Interdisciplinary treatment of unruptured intracranial aneurysms: impact of intraprocedural rupture and ischemia in 563 aneurysms. J Neurol 260:1304–1313. https://doi.org/10.1007/s00415-012-6795-9 - DOI - PubMed
    1. Yao PS, Chen GR, Zheng SF et al (2017) Predictors of postoperative cerebral ischemia in patients with ruptured anterior communicating artery aneurysms. World Neurosurg 103:241–247. https://doi.org/10.1016/j.wneu.2017.04.007 - DOI - PubMed

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