title: Is the surgical repair of unruptured atherosclerotic aneurysms at a higher risk of intraoperative ischemia?
abstract: BACKGROUND
  The incidence of ischemia might be increased in the surgical repair of atherosclerotic unruptured aneurysms compared to non-atherosclerotic aneurysms. The atherosclerotic wall might increase the occurrence of thrombembolic events or its rigidity might endanger the occlusion of perforators within the aneurysm vicinity.
  
  
  METHODS
  87 patients (53 patients without and 34 patients with atherosclerotic unruptured aneurysms, 50.5 ± 9.7 years) were analyzed for severity of atherosclerosis within the aneurysm and the aneurysm bearing vessel, surgical maneuvers, intraoperative alterations in evoked potentials and clinical and neuroradiological results.
  
  
  RESULTS
  Temporary vessel occlusion (25% vs. 50%, p = 0.021), repositioning of a permanent clip (21% vs. 56%, p = 0.001) and aneurysm remnants (2% vs. 18%, p = 0.012) occurred more often in patients with atherosclerotic aneurysms. At 6 months, 3/34 patients with atherosclerosis (8.8%) had an unfavorable outcome, all patients without atherosclerosis had a favorable outcome (p = 0.056).
  
  
  CONCLUSIONS
  The surgical repair of unruptured aneurysms is safe but patients with atherosclerotic altered vessels and aneurysms accounted to a minor increase in unfavorable outcome and an increased risk of morbidity at 6 months postoperatively. This factor should be taken into consideration when performing surgery of atherosclerotic, unruptured aneurysms.
authors.affiliation: Department for Neurosurgery, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany. A.Szelenyi@em.uni-frankfurt.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Szelényi
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Reinhard
authors.initials: R
authors.lastname: Strametz
authors.forename: Stella
authors.initials: S
authors.lastname: Blasel
authors.forename: Agi
authors.initials: A
authors.lastname: Oszvald
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000328:Adult; D000375:Aging / Q000502:physiology; D000758:Anesthesia; D050197:Atherosclerosis / Q000150:complications*; D002545:Brain Ischemia / Q000209:etiology*; D004569:Electroencephalography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000209:etiology / Q000601:surgery*; D007431:Intraoperative Complications / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D013923:Thromboembolism / Q000150:complications; D016896:Treatment Outcome