Turkish neurosurgery · 2023
Comparative Analysis of Clipping and Endovascular Therapy Outcomes in the Treatment of Ruptured Distal Anterior Cerebral Artery Aneurysms.
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Jha Vikas Chandra, Alam Shahnawaz, Sinha Vivek Saran
Аннотация
AIM: To compare the outcomes of distal anterior cerebral artery (DACA) aneurysm treatment using endovascular therapy (EVT) and surgical clipping, and to assess their risk factors.
MATERIAL AND METHODS: We retrospectively sampled and analyzed 31 patients treated for ruptured Distal anterior cerebral artery (DACA) aneurysms from a larger sample of 250 patients treated for ruptured aneurysms between July 2018 and July 2021. The outcomes of patients who underwent clipping and EVT were compared using chi-square tests. T-tests were used for univariate analysis and a logistic regression analysis was used to determine the risk factors affecting outcomes.
RESULTS: Of the 31 patients, 20 were treated with clipping and 11 with EVT. Patients treated with EVT had a mean age of 35.45 ± 6.66. The mean age of the clipping group was 44.4 ± 6.94 years (p=0.002). Intraoperative rupture was significantly more common in the clipping group (p=0.025). There were no significant differences in the postoperative incidence of vasospasm or hydrocephalus (p=0.12). Modified Rankin Scale scores (p=0.017) and Glasgow Outcome Scale scores (p=0.02) both at discharge and 6-month follow-ups were significantly better in the EVT group than in the clipping group. Length of stay in the Intensive Care Unit (ICU) was 9.27 ± 2.6 days following EVT and 23.60 ± 6.29 following clipping (p=0.001). Age (p=0.0136), Hunt and Hess grade (p=0.02), and the occurrence of intraprocedural rupture (p=0.009) were found to significantly affect outcomes.
CONCLUSION: The outcomes of EVT were better than those for clipping and required a shorter stay in the ICU and the hospital. This may be partially attributable to the dual-trained neurovascular surgeon who performed the procedures. Older age, poorer Hunt and Hess grades, and intraoperative aneurysm rupture adversely affected outcomes.
MATERIAL AND METHODS: We retrospectively sampled and analyzed 31 patients treated for ruptured Distal anterior cerebral artery (DACA) aneurysms from a larger sample of 250 patients treated for ruptured aneurysms between July 2018 and July 2021. The outcomes of patients who underwent clipping and EVT were compared using chi-square tests. T-tests were used for univariate analysis and a logistic regression analysis was used to determine the risk factors affecting outcomes.
RESULTS: Of the 31 patients, 20 were treated with clipping and 11 with EVT. Patients treated with EVT had a mean age of 35.45 ± 6.66. The mean age of the clipping group was 44.4 ± 6.94 years (p=0.002). Intraoperative rupture was significantly more common in the clipping group (p=0.025). There were no significant differences in the postoperative incidence of vasospasm or hydrocephalus (p=0.12). Modified Rankin Scale scores (p=0.017) and Glasgow Outcome Scale scores (p=0.02) both at discharge and 6-month follow-ups were significantly better in the EVT group than in the clipping group. Length of stay in the Intensive Care Unit (ICU) was 9.27 ± 2.6 days following EVT and 23.60 ± 6.29 following clipping (p=0.001). Age (p=0.0136), Hunt and Hess grade (p=0.02), and the occurrence of intraprocedural rupture (p=0.009) were found to significantly affect outcomes.
CONCLUSION: The outcomes of EVT were better than those for clipping and required a shorter stay in the ICU and the hospital. This may be partially attributable to the dual-trained neurovascular surgeon who performed the procedures. Older age, poorer Hunt and Hess grades, and intraoperative aneurysm rupture adversely affected outcomes.