Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy.
Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy.
Neurosurg Rev. 2022 Apr;45(2):1089-1100. doi: 10.1007/s10143-021-01647-6. Epub 2021 Oct 7.
The aim of this study is to compare occlusion rate, complication rate, and clinical outcome of microsurgical clipping (MC) and advanced endovascular techniques (EVT) in unruptured anterior communicating artery-complex aneurysms (ACoCAs). We reviewed the scientific literature reporting occlusion rate, time of occlusion assessment, and clinical outcome of MC and EVT in patients with unruptured ACoCAs, from January 2009 to December 2019. We included in our analysis 25 studies and 872 patients with unruptured ACoCAs (434 treated with endovascular techniques and 438 with MC). Ninety-three (10.7%), 320 (36.7%), 21 (2.4%), and 438 (50.2%) were treated with flow diverter (FD), stent-assisted coiling (SAC), endosaccular devices (ES), and microsurgical clipping (MC) respectively. FD, SAC, ES, and MC subgroups presented minor complications in 11.8%, 3.8%, 14.3%, and 7.1% of cases (p=.016), and major complications in 3.2%, 4.4%, 0%, and 7.1% (p=.136) of patients. A total occlusion rate post-treatment has been achieved in 4.3%, 87.1%, 47.6%, and 98.2% of cases (p=.000), while at 12 months' follow-up in 50%, 66%, 83.3%, and 80% of patients (p=.001). FD, SAC, ES, and MC subgroups had a good clinical outcome at 12 months in 93.5%, 90.5%, 100%, and 67.8% of cases. MC is associated with higher post-treatment total occlusion rate, but higher complication and lower good clinical outcome rates. EVT are promising in treating unruptured anterior cerebral artery aneurysms with high margin of safety and good clinical outcome, despite the lower total occlusion rate.
本研究旨在比较未破裂前交通动脉复合体动脉瘤（ACoCA）中显微夹闭（MC）和先进的血管内技术（EVT）的闭塞率、并发症率和临床结果。我们回顾了 2009 年 1 月至 2019 年 12 月期间报告未破裂 ACoCA 患者 MC 和 EVT 闭塞率、闭塞评估时间和临床结果的科学文献。我们纳入了 25 项研究和 872 例未破裂 ACoCA 患者（434 例接受血管内治疗，438 例接受 MC 治疗）的分析。93（10.7%）、320（36.7%）、21（2.4%）和 438（50.2%）分别接受了血流导向装置（FD）、支架辅助线圈（SAC）、血管内支架（ES）和显微夹闭（MC）治疗。FD、SAC、ES 和 MC 亚组分别有 11.8%、3.8%、14.3%和 7.1%的患者发生轻微并发症（p=.016），3.2%、4.4%、0%和 7.1%的患者发生严重并发症（p=.136）。治疗后完全闭塞率分别为 4.3%、87.1%、47.6%和 98.2%（p=.000），而 12 个月随访时分别为 50%、66%、83.3%和 80%（p=.001）。FD、SAC、ES 和 MC 亚组在 12 个月时的临床结果分别为 93.5%、90.5%、100%和 67.8%。MC 治疗后完全闭塞率较高，但并发症发生率和临床结果良好率较低。尽管完全闭塞率较低，但 EVT 在治疗未破裂大脑前动脉动脉瘤方面具有较高的安全性和良好的临床效果。
