Dawod Giana, Henkel Nicholas D, Salahuddin Hisham, Castonguay Alicia C, Koneru Sitara, Mugge Luke, Khuder Sadik A, Medhkour Azedine, Jumaa Mouhammad A
Neurological Surgery, The University of Toledo Medical Center, Toledo, OH, USA.
Neurology, The University of Toledo Medical Center, Toledo, OH, USA.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105039. doi: 10.1016/j.jstrokecerebrovasdis.2020.105039. Epub 2020 Jun 24.
Data comparing the effect of age on outcomes of patients who underwent either endovascular coiling (EVC) or neurosurgical clipping (NSC) for ruptured intracranial aneurysms remains limited.
To better elucidate the preferred intervention for ruptured aneurysm management by presenting the results of our systematic review of the literature that evaluated the potential advantages of the two interventions between different age groups.
Systematic review of PubMed and Embase was performed (2002 - June 10, 2019) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2013 guidelines. Median ages of EVC and NSC cohorts were 54 and 56, respectively. Ages below the median were used in our "younger" cohort; ages above the median were used in our "older" cohort.
We reviewed 13 studies on 7,137 patients. In the younger cohort, there were 2840 (EVC: 1412, NSC: 1428) patients. In the older cohort, there were 4297 (EVC: 2552, NSC: 1745) patients. Overall, there was a significant difference in functionality between EVC (77.70%) and NSC (69.23%) (OR=1.69; 95% C.I.: 1.10-2.60, p = 0.0212). In our younger cohort, functionality was significantly different between EVC (77%) and NSC (69%) (OR=1.54; 95% C.I.: 1.29-1.84, p < 0.001). For the older cohort, there was no significant difference in functionality, complications, or efficacy.
We have highlighted the importance of considering age prior to deciding which intervention is most appropriate for ruptured aneurysms, with higher morbidity and mortality with NSC versus EVC in the younger population.
关于年龄对接受血管内栓塞术（EVC）或神经外科夹闭术（NSC）治疗颅内破裂动脉瘤患者预后影响的比较数据仍然有限。
通过展示我们对文献的系统评价结果，以更好地阐明颅内破裂动脉瘤治疗的首选干预措施，该评价评估了不同年龄组两种干预措施的潜在优势。
按照系统评价和Meta分析的首选报告项目（PRISMA）2013指南，对PubMed和Embase进行了系统评价（2002年至2019年6月10日）。EVC组和NSC组的中位年龄分别为54岁和56岁。年龄低于中位数的纳入我们的“较年轻”队列；年龄高于中位数的纳入我们的“较年长”队列。
我们回顾了13项研究，共7137例患者。较年轻队列中有2840例患者（EVC组：1412例，NSC组：1428例）。较年长队列中有4297例患者（EVC组：2552例，NSC组：1745例）。总体而言，EVC组（77.70%）和NSC组（69.23%）在功能方面存在显著差异（OR=1.69；95%置信区间：1.10-2.60，p = 0.0212）。在我们的较年轻队列中，EVC组（77%）和NSC组（69%）在功能方面存在显著差异（OR=1.54；95%置信区间：1.29-1.84，p<0.001）。对于较年长队列，在功能、并发症或疗效方面没有显著差异。
我们强调了在决定哪种干预措施最适合颅内破裂动脉瘤之前考虑年龄的重要性，在较年轻人群中，NSC组的发病率和死亡率高于EVC组。
