Taheri Zeinab, Harirchian Mohammad Hosein, Ghanaati Hosein, Khoshnevisan Alireza, Salamati Payman, Miri Mojtaba, Firouznia Kavous, Saeednejad Mina, Shakiba Madjid, Rahimi-Movaghar Vafa
Department of Neurology, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Neurol. 2015 Jan 5;14(1):22-8.
Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping.
This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients) or surgical clipping (21 patients) from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention.
Mean modified Rankin Scale (MRS) score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040). Focal neurologic signs were higher in clipping during procedures (P = 0.0310). Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090), but not in clipping group (P = 0.8750). Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000).
There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.
近年来，颅内动脉瘤的治疗引发了关于最佳治疗方式的争论。本研究的目的是比较两组患者的介入治疗结果，一组采用血管内栓塞治疗，另一组采用手术夹闭治疗。
这项前瞻性研究纳入了2011年7月至2013年8月期间接受血管内栓塞治疗（27例患者）或手术夹闭治疗（21例患者）的48例颅内动脉瘤患者。一名神经科医生在患者入院时对其进行检查，并在干预后1年通过电话随访。
血管内栓塞组入院时改良Rankin量表（MRS）平均评分为2.86±0.974，而手术夹闭组为3.81±1.078（P = 0.0040）。手术过程中夹闭时的局灶性神经体征更高（P = 0.0310）。在37例随访1年的患者中，血管内栓塞组19例，手术夹闭组18例。在1年随访时，栓塞组MRS改善具有统计学意义（P = 0.0090），而夹闭组无统计学意义（P = 0.8750）。血管内栓塞组入院时与1年后MRS评分的平均差值为0.947±1.224，手术组为0.111±2.083（P = 0.3000）。
两组在1年结局上无统计学显著差异。我们建议进行更大样本量的进一步介入研究，以更好地评估这些治疗方式。
