Therapeutic Effect of Vascular Intervention Embolization at Different Timing for Aneurysmal Subarachnoid Hemorrhage and the Influencing Factors of Postoperative Cognitive Dysfunction

ZHU Shuai; LIU Yanzhen; WANG Xiangge

doi:10.3969/j.issn.1004-437X.2025.15.020

Abstract：Objective To explore the therapeutic effects of vascular intervention and embolization in the treatment of aneurysmal subarachnoid hemorrhage(aSAH)at different times,and analyzing the factors affecting postoperative cognitive dysfunction.Methods From January 2021 to June 2023,102 patients with aSAH in Nanshi Hospital of Nanyang were selected and divided into an early group(53 cases of vascular intervention embolization within 72 hours of admission)and an advanced group(49 cases of vascular intervention embolization after 72 hours of admission)according to the timing of treatment.The embolization effects,endothelial function,and complications of the two groups were compared.Three months after surgery,41 cases were divided into a cognitive impairment group and 61 cases into a cognitive normal group according to the Montreal cognitive assessment scale(MoCA).The influencing factors of postoperative cognitive impairment in patients with aSAH were analyzed.Results Compared with the total embolism rate of 81.63％in the late stage group,the early stage group had a higher rate of 94.34％(P＜0.05).Compared with before treatment,the levels of nitric oxide synthase(NOS),endothelin-1(ET-1),and vascular endothelial growth factor(VEGF)decreased in both groups after 2 weeks of treatment(P＜0.05),and compared with the advanced group,the early group had lower levels of NOS,ET-1,and VEGF after 2 weeks of treatment(P＜0.05).Compared with the late stage group with a complication rate of 16.33％,the early stage group had a lower incidence of 3.77％(P＜0.05).Compared with the normal cognitive group,the cognitive impairment group had higher age,neuron-specific enolase(NSE),cystatin C(Cys-C),S100β protein(S100β),new cerebral infarction rate,and late treatment rate(P＜0.05).The cognitive impairment group had a longer operation duration(P＜0.05),and a lower rate of symmetrical development of bilateral A1(P＜0.05).According to binary logistic regression analysis,long duration of surgery,new onset of cerebral infarction,high S100 β and advanced treatment timing were risk factors for postoperative cognitive impairment in aSAH patients(P＜0.05).Conclusion Compared with late vascular interventional embolization therapy,early vascular interventional embolization therapy for aSAH has better embolization effect,less impact on vascular endothelial function,and lower complications.Postoperative cognitive dysfunction is related to the duration of the surgery,new cerebral infarction,S100β,and the timing of treatment.