A Meta-analysis of effect comparison between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms / 重庆医学

ABSTRACT

Objective To compare the efficacies between interventional embolization and surgical clipping in treatment of ruptured intracranial aneurysms to provide an evidence‐based basis for selecting the clinical treatment scheme .Methods The related randomized controlled trail(RCT) literatures on the effects of interventional embolization and surgical clipping were retrieved from the databases of Pubmed ,Cochrane ,Medline and Embase .The screening was independently performed by two researchers according to the including and excluding criterion .The occurrence rate of adverse reactions ,postoperative 1‐year mortality rate ,re‐bleeding rate ,occurrence rate of vasospasm and ischemic cerebral infarction served as the measurement indicators .The data were extracted and performed the meta analysis by the RevMan5 .3 software .Results Sixteen RCT literatures were included for conducting analy‐sis ,involving 7 373 patients ,in which 3 092 cases adopted interventional embolization and 4 281 cases adopted surgical clipping .The occurrence rate of adverse events(OR=1 .25 ,95% CI ,1 .12-1 .40 ;P<0 .000 1) and re‐bleeding rate(OR=0 .43 ,95% CI ,0 .28 -0 .66 ;P=0 .000 1) in the interventional embolization group were lower than those in the surgical clipping group ;however ,there were no statistical differences between the interventional embolization group and surgical clipping group in the postoperative 1‐year mortality rate(OR=1 .13 ,95% CI ,0 .92-1 .39 ;P=0 .23) ,incidence rate of vasospasm (OR=1 .41 ,95% CI ,0 .99-2 .02 ;P=0 .06) and incidence rate of ischemic cerebral infarction(OR=0 .66 ,95% CI ,0 .42 -1 .05 ;P=0 .08) .Conclusion The current clinical re‐search evidences indicate that using the interventional embolization in treating ruptured intracranial aneurysms can obviously reduce the occurrence rate of adverse events than the surgical clipping ,but increases the re‐bleeding rate .The postoperative 1‐year mortali‐ty rate ,incidence rate of vasospasm and incidence rate of ischemic cerebral infarction have no obvious difference between these two kinds of operation .