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 () 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.

中文翻译：

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未破裂颅内动脉瘤血管内治疗后视网膜动脉/小动脉闭塞的风险

背景 评估视网膜动脉/小动脉闭塞 (RAO) 与未破裂颅内动脉瘤 (UIA) 之间的关联。方法 将来自全国队列的 UIA 患者 (n=253 240) 根据后续治疗分为三组：观察组 (n=208 993)、显微手术夹闭组 (n=14 168) 和血管内治疗 (EVT) 组 (n= 30079）。分析 RAO 的发生率和发生时间。评估了 RAO 的 HR 和相关风险因素。此外，还对由 2569 名在三级医院接受治疗的连续 UIA 患者组成的医院队列进行了分析，其中包含 UIA 的详细临床信息。结果 在全国队列分析中，EVT组RAO发生率显着高于观察组和剪报组，尤其是60天内（早期RAO（60天内）：HR=4.00，95% CI：2.44～6.56）；延迟 RAO（60 天后）：HR=1.74，95% CI：1.13 至 2.68）。多变量分析表明，存在慢性肾脏疾病 (p=0.009) 和手术期间使用球囊微导管 (p=0.013) 与 RAO 风险较高相关。在医院队列分析中，EVT 后发生 11 例 (0.8%) RAO 病例，而显微手术夹闭后无一例发生 (p<0.001)。RAO 患者比其他患者更年轻，接受球囊微导管治疗的频率也更高。10 例 RAO (90.9%) 发生在床突旁动脉瘤，其中 EVT 优于显微手术夹闭。结论 对 UIA 进行 EVT 可能会增加随后发生 RAO 的风险。用球囊微导管治疗床突旁动脉瘤时应小心。可根据合理要求提供数据。全国队列中的所有原始数据都可以通过健康保险审查和评估 (HIRA) 医疗保健大数据中心服务器访问。通过 HIRA 医疗保健大数据中心主页提交的理赔数据的应用（）由研究支持审议委员会审查，一旦获得批准，原始数据将有偿提供给授权研究人员。获得许可后，通过远程访问 HIRA 服务器来分析数据。整个数据集只能通过连接到 HIRA 服务器进行处理，分析后的数据可以在 HIRA 批准的情况下导出。匿名数据集和医院队列的分析代码可供研究人员使用，其数据使用方案已获得 HIRA 批准。独立审查委员会应通讯作者的要求 (kyjcolor@yuhs.ac)。为了获得访问权限，数据请求者需要签署数据访问协议。