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). Conclusion 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.