Comparative analysis of the efficacy of endovascular treatment and surgical clipping for intracranial ruptured aneurysms: a single-center retrospective case series study / 国际脑血管病杂志

ABSTRACT

Objective To investigate the safety and effectiveness of endovascular treatment and surgical clipping for the treatment of intracranial ruptured aneurysms. Methods From January 2012 to December 2017, patients with ruptured intracranial aneurysm treated at the Department of Neurosurgery, the Second People's Hospital of Taizhou were enrolled retrospectively. The demographics, baseline clinical data,outcomes, and complications were compared between the endovascular treatment group and the surgical clip group. Results A total of 220 patients were enrolled, they aged 55. 1 ±11. 8 years. There were 117 patients in the endovascular treatment group and 103 in the surgical clipping group. There were no significant differences in perioperative complications (26. 2％ vs. 19. 6％; χ2 = 1. 340, P = 0. 247), in-hospital mortality (6. 0％vs. 4. 9％; χ2 = 0. 135, P = 0. 713), and good outcomes at discharge (85. 5％ vs. 81. 6％; χ2 =0. 614, P = 0. 433) between the two groups. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1. 072, 95％ confidence interval [CI] 1. 025-1. 124; P < 0. 001), smoking (OR 6. 325, 95％ CI 2. 367-16. 901; P < 0. 001 ), and high World Federation of Neurosurgery Societies (WFNS) grade (OR 5. 218, 95％ CI 1. 881-14. 449; P < 0. 001) had significant independent correlation with the poor clinical outcome at discharge. The imaging follow-up data in 155 aneurysms (81 in the endovascular treatment group and 74 in the surgical clipping group) were available. The follow-up time was 14. 3 ± 6. 9 months (range, 6-36 months); 20 aneurysms (12. 9％) had recurrence. There was no significant difference in the recurrence rate of the endovascular treatment group and surgical clipping group (17. 3％ vs. 8. 1％; χ2 =2. 900, P = 0. 089). The clinical follow-up data of 188 patients (95 in the endovascular treatment group and 93 in the surgical clipping group) were available. The follow-up time was 15. 5 ± 6. 8 months (range, 6- 36 months). There was no significant difference in the good outcome rate between the endovascular treatment group and surgical clipping group (95. 8％ vs. 90. 3％; χ2 = 2. 182, P = 0. 140 ). Multivariate logistic analysis showed that smoking (OR 4. 872, 95％ CI 1. 719-13. 872; P < 0. 001 ) and high WFNS grade (OR 3. 512, 95％ CI 1. 446-8. 583; P < 0. 001) were the independent risk factor for long-term poor outcome. Conclusion The efficacy and safety of surgical clipping for ruptured intracranial aneurysms were comparable to endovascular treatment. Age, smoking, and WFNS grade were the important factors affecting the outcomes of patients.