Influence of Blood Pressure Change on Cerebral Perfusion During Interventional Embolization of Intracranial Aneurysm

Abstract Background : Rupture and hemorrhage of intracranial aneurysms constitute the leading cause of spontaneous subarachnoid hemorrhage. Endovascular embolization is the primary treatment for intracranial aneurysms, where intraoperative blood pressure management is critical to prevent aneurysm rupture and cerebral hypoperfusion. However, unified optimal intraoperative and postoperative blood pressure control standards remain undefined due to insufficient clinical evidence. Methods: This study aimed to explore risk factors for cerebral hypoperfusion during intracranial aneurysm embolization and provide evidence for precise anesthetic management. Results Of the 89 patients included, 55 (61.8%) developed postoperative PI > 1.1. The hypoperfusion group had a higher proportion of hypertension (60.0% vs. 32.4%, P = 0.021) and greater intraoperative SBP variance (median 652.82 vs. 373.19 mmHg², P = 0.009). Multivariable analysis identified hypertension (a OR 2.72, 95% CI 1.09–6.81, P = 0.033) and SBP variance (a OR 1.02, 95% CI 1.00–1.04, P = 0.009) as independent predictors of PI > 1.1. A significant interaction was found between hypertension and SBP variance ( P = 0.022); the effect of hypertension was strongest in patients with above-median SBP variance (aOR 20.68, 95% CI 2.25–190.49, P = 0.007). The nomogram integrating these two predictors showed moderate discrimination (AUC 0.706, 95% CI 0.599–0.813). Conclusions: In conclusion, intraoperative systolic blood pressure variability and a history of hypertension are independently linked to postoperative cerebral hypoperfusion following endovascular embolization of intracranial aneurysms. Hypertensive patients are particularly sensitive to blood pressure changes. A baseline diastolic blood pressure of 96 mmHg appears to have a threshold effect. A straightforward nomogram based on these factors could aid in personalized blood pressure control and risk assessment during and after endovascular aneurysm interventions. Further validation in larger cohorts is necessary.