Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
World Neurosurg. 2021 May;149:e336-e344. doi: 10.1016/j.wneu.2021.02.027. Epub 2021 Feb 17.
Although intracranial aneurysms are increasingly treated endovascularly, microsurgical clipping has been the standard approach for middle cerebral artery (MCA) aneurysms. We compared microsurgical clipping and state-of-the-art endovascular treatment of unruptured MCA bifurcation aneurysms treated at a neurovascular center following a "coil-first" policy.
This single-center study included 148 patients treated for 160 unruptured MCA bifurcation aneurysms. Technical success, complications, clinical outcome, and angiographic results were retrospectively compared.
Microsurgical clipping was performed for 120 MCA aneurysms (75%) and endovascular treatment for 40 (25%; conventional coiling: 8, stent-assisted coiling: 16, balloon-assisted coiling: 3, and flow-disruption: 13). Technical treatment success was higher in the clipping group (100%) than in the endovascular group (92.5%, P = 0.015). Overall, complications occurred in 16.7% for clipping and in 20.0% for endovascular treatment (P = 0.631). Major ischemic stroke rates were 4.2% in the clipping group and 7.5% in the endovascular group (P = 0.414). At 6 months, a favorable outcome was obtained by 99.2% after clipping and 95.0% after endovascular treatment (P = 0.154). The 6-month complete aneurysm occlusion rates were by trend higher in the clipping group (89.2%) than in the endovascular group (75.9%, P = 0.078).
Microsurgical clipping was associated with a higher technical success rate and tendentially higher complete occlusion than endovascular treatment, with no additional morbidity and similar clinical outcome. On the basis of these results, clipping proves to be the standard treatment option for MCA bifurcation aneurysms. However, endovascular treatment represents a safe and efficient alternative treatment option for patients.
尽管颅内动脉瘤的血管内治疗越来越普遍，但对于大脑中动脉（MCA）动脉瘤，显微夹闭一直是标准的治疗方法。我们比较了在神经血管中心采用“先圈后夹”策略治疗的未破裂 MCA 分叉部动脉瘤中，显微夹闭和最先进的血管内治疗的效果。
这是一项单中心研究，共纳入 148 例接受治疗的 160 例未破裂 MCA 分叉部动脉瘤患者。回顾性比较了技术成功率、并发症、临床转归和血管造影结果。
120 例 MCA 动脉瘤（75%）采用显微夹闭治疗，40 例（25%；传统线圈栓塞：8 例，支架辅助线圈栓塞：16 例，球囊辅助线圈栓塞：3 例，血流阻断：13 例）采用血管内治疗。夹闭组的技术治疗成功率（100%）明显高于血管内组（92.5%，P=0.015）。总的来说，夹闭组的并发症发生率为 16.7%，血管内组为 20.0%（P=0.631）。夹闭组和血管内组的主要缺血性卒中发生率分别为 4.2%和 7.5%（P=0.414）。夹闭组和血管内组的 6 个月时的良好转归率分别为 99.2%和 95.0%（P=0.154）。夹闭组的 6 个月完全动脉瘤闭塞率（89.2%）略高于血管内组（75.9%，P=0.078）。
与血管内治疗相比，显微夹闭具有更高的技术成功率和更高的完全闭塞倾向，且不会增加发病率，临床转归相似。基于这些结果，夹闭被证明是 MCA 分叉部动脉瘤的标准治疗选择。然而，血管内治疗为患者提供了一种安全有效的替代治疗选择。
