{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T12:40:05Z","timestamp":1748263205205,"version":"3.41.0"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the safety and efficacy of endovascular embolization combined with external drainage for poor\u2010grade ruptured cerebral aneurysms and risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Forty\u2010six patients with poor\u2010grade ruptured cerebral aneurysms treated with endovascular embolization combined with decompressive craniectomy and drainage were retrospectively enrolled.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Coil embolization alone was performed in 29 (63.0%) patients, stent\u2010assisted coiling in 14 (30.4%), and coiling with the assistance of two microcatheters in three (6.5%). Immediately after embolization, aneurysm occlusion degree was Raymond\u2010Roy grade I in 88% (44\/50), II in 8% (4\/50), and III in 4% (2\/50). Periprocedural complications occurred in four (8.7%) patients. Forty\u2010two (91.3%) patients had lumbar cistern drainage (<jats:italic>n<\/jats:italic>\u2009=\u200929 or 63.0%), extraventricular drainage (<jats:italic>n<\/jats:italic>\u2009=\u200911 or 23.9%), or decompressive craniectomy (<jats:italic>n<\/jats:italic>\u2009=\u20092 or 4.3%). At discharge, six (13.0%) patients died, and hydrocephalus took place in 16 (34.8%) patients. Better outcomes (mRS 0\u20132) were achieved in 31 (67.4%), including 23 (50.0%) patients below 60\u2009years and eight (17.4%) over 60\u2009years. Better clinical outcomes were achieved in patients below 60\u2009years and with lumbar cistern drainage, and age was the only significant independent risk factor for better clinical outcomes. Receiver characteristics curve analysis of age for better clinical outcomes revealed that the cutoff value was 61\u2009years, with the AUC 0.73, sensitivity 0.69, and specificity 0.73.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Endovascular embolization combined with decompressive craniectomy and drainage may be safe and efficient for poor\u2010grade ruptured cerebral aneurysms, and older age and drainage modality may significantly affect the clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.19349","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T08:48:06Z","timestamp":1736412486000},"page":"972-978","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and efficacy of endovascular embolization combined with external drainage for poor\u2010grade ruptured cerebral aneurysms"],"prefix":"10.1111","volume":"95","author":[{"given":"Shi\u2010Dun","family":"Chen","sequence":"first","affiliation":[{"name":"China Medical University  Shenyang China"},{"name":"Department of Neurosurgery Liaoyang City Central Hospital  Liaoyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng\u2010Bao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Liaoyang City Central Hospital  Liaoyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong\u2010Xiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Liaoyang City Central Hospital  Liaoyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue\u2010Han","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Liaoyang City Central Hospital  Liaoyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4668-0737","authenticated-orcid":false,"given":"Bulang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Liaoyang City Central Hospital  Liaoyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun\u2010Guang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Liaoyang City Central Hospital  Liaoyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2013.08.024"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000183"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4649"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2019.04.010"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2302\/kjm.46.69"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2004.03.021"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-018-1031-4"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.07.004"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-84339-x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000303188.72425.24"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000000677"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002307"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(00)00170-1"},{"key":"e_1_2_8_15_1","first-page":"596","article-title":"Endovascular management of poor\u2010grade aneurysmal subarachnoid hemorrhage in the geriatric population","volume":"25","author":"Jain R","year":"2004","journal-title":"AJNR Am. 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