2110 Association of Time Elapsed Since Ischemic Stroke With Risk of Perioperative Stroke in Patients Undergoing Unruptured Intracranial Aneurysm Procedures

INTRODUCTION: In patients with unruptured intracranial aneurysms (UIAs) who have recently experienced an ischemic stroke, determining the optimal timing for clipping or coiling is critical. Currently, no studies have specifically explored this issue. METHODS: This study is based on the registered CAIASA study and includes patients treated for UIAs between October 2015 and December 2020 at Beijing Tiantan Hospital, China. Clinical outcomes included symptomatic perioperative stroke confirmed by radiology examinations and unfavorable outcomes, measured by the modified Rankin Score. Patients were categorized into five groups based on the time elapsed since their ischemic stroke: no history of stroke, less than 1 month, 1-3 months, 4-9 months, and more than 9 months prior to the procedure. Multivariable logistic regression was used for analysis. RESULTS: A total of 3029 patients were included, with 486 having a history of ischemic stroke and 2543 without. Perioperative stroke occurred in 4.8% (123/2543) of patients without a history of ischemic stroke, compared to 14.0% (8/57) in the less than 1 month group, 13.3% (15/113) in the 1-3 months group, 8.0% (7/88) in the 4-9 months group, and 8.8% (20/228) in the more than 9 months group. Patients with a stroke history of less than 1 month and 1-3 months before the procedure had a significantly increased risk of perioperative stroke (adjusted OR = 3.0 [1.3-6.9] and aOR = 2.2 [1.1-4.1], respectively). No significant associations were observed for the 4-9 months and more than 9 months groups (aOR = 1.1 [0.5-2.7] and aOR = 1.4 [0.8-2.4], respectively). A linear trend was observed between the time elapsed since the ischemic stroke and the risk of perioperative stroke (P for trend < 0.001). CONCLUSIONS: For UIAs patients with recent ischemic stroke, the risk of perioperative stroke leveled off when more than 3 months elapsed between a previous stroke and procedures. These findings suggest delaying the UIAs procedures at least 3 months after a recent stroke.