PT - JOURNAL ARTICLE AU - Kim, Hae Rang AU - Kim, Min Jeoung AU - Kim, Sunyeup AU - Chang, Myung Soo AU - Kim, Dong Joon AU - Kim, Byung Moon AU - Park, Keun Young AU - Kim, Yong Bae AU - Lee, Christopher Seungkyu AU - Byeon, Suk Ho AU - Kim, Sung Soo AU - Lee, Seung Won AU - Kim, Yong Joon TI - Retinal artery/arteriole occlusion risks after endovascular treatment for unruptured intracranial aneurysm AID - 10.1136/svn-2023-002563 DP - 2024 Jun 01 TA - Stroke and Vascular Neurology PG - 295--305 VI - 9 IP - 3 4099 - http://svn.bmj.com/content/9/3/295.short 4100 - http://svn.bmj.com/content/9/3/295.full SO - Stroke Vasc Neurol2024 Jun 01; 9 AB - Background To evaluate the association between retinal artery/arteriole occlusion (RAO) and unruptured intracranial aneurysm (UIA).Methods Incident UIA patients from a nationwide cohort (n=253 240) were categorised into three groups based on subsequent treatment: observation (n=208 993), microsurgical clipping (n=14 168) and endovascular treatment (EVT) groups (n=30 079). The incidence and the incident time of RAO were analysed. HRs of RAO and associated risk factors were evaluated. Additionally, a hospital cohort comprising 2569 consecutive UIA patients treated at a tertiary hospital was analysed with detailed clinical information of UIAs.Results In the nationwide cohort analysis, the incidence of RAO was significantly higher in EVT group than in observation and clipping groups, especially within 60 days (early RAO (within 60 days): HR=4.00, 95% CI: 2.44 to 6.56); delayed RAO (after 60 days): HR=1.74, 95% CI: 1.13 to 2.68). Multivariable analysis showed that the presence of chronic kidney disease (p=0.009) and use of a balloon microcatheter during the procedure (p=0.013) were associated with a higher risk of RAO. In hospital cohort analysis, 11 (0.8%) cases of RAO occurred after EVT, whereas none occurred after microsurgical clipping (p<0.001). Patients with RAO were younger and received balloon microcatheters more frequently than their counterparts. Ten cases of RAO (90.9%) occurred in paraclinoid aneurysms, where EVT was preferred over microsurgical clipping.Conclusions Performing EVT for UIA may increase the risk of subsequent RAO. Care should be taken when treating paraclinoid aneurysms with balloon microcatheters.Data are available on reasonable request. All raw data in nationwide cohort can be accessed via the Health Insurance Review and Assessment (HIRA) Healthcare Bigdata Hub server. The application of the claims data submitted through the HIRA Healthcare Bigdata Hub homepage (https://opendata.hira.or.kr/home.do) is reviewed by the deliberative committee of research support, and once approved, raw data are provided to the authoriszed researcher at a fee. After obtaining permission, data were analysed using remote access to the HIRA server. The entire dataset can be handled only through a connection to the HIRA server, and the analysed data can be exported with HIRA approval.The anonymised dataset and analytical codes of hospital cohort were available to researchers whose proposed use of the data has been approved by an independent review committee on request to the corresponding author (kyjcolor@yuhs.ac). To gain access, data requestors will need to sign a data access agreement.