破裂颅内动脉瘤血管内或显微手术闭塞后的多维结局——一项瑞士前瞻性多中心研究的比较分析
Multidimensional outcome after endovascular or microsurgical occlusion of ruptured intracranial aneurysms - Comparative analysis of a prospective Swiss multicenter study.
作者信息
Kälin Vincens, Stienen Martin N, Zindel-Geisseler Olivia, Dannecker Noemi, Rothacher Yannick, Schlosser Ladina, Velz Julia, Sebök Martina, Eggenberger Noemi, May Adrien, Bijlenga Philippe, Guerra-Lopez Ursula, Maduri Rodolfo, Starnoni Daniele, Beaud Valérie, Chiappini Alessio, Robert Thomas, Bonasia Sara, Rossi Stefania, Goldberg Johannes, Fung Christian, Bervini David, Gutbrod Klemens, Maldaner Nicolai, Früh Severin, Schwind Marc, Zeitlberger Anna-Maria, Hostettler Isabel C, Bozinov Oliver, Brugger Peter, Germans Menno R, Regli Luca
机构信息
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
出版信息
Brain Spine. 2025 Apr 29;5:104262. doi: 10.1016/j.bas.2025.104262. eCollection 2025.
INTRODUCTION
Despite advances in cerebral aneurysm treatment, information on detailed outcomes remains limited. We compared complications and multidimensional outcomes in alert aneurysmal subarachnoid hemorrhage (aSAH) patients (GCS ≥13) who received clipping or coiling after individualized decisions were made through multidisciplinary board discussions.
RESEARCH QUESTION
Are there significant differences in multidimensional outcomes between clipping and coiling treatments for alert aSAH patients when treatment selection is individualized?
MATERIAL AND METHODS
Within the prospective MoCA-DCI study (ClinicalTrials.gov identifier: NCT03032471), patients with a GCS of 13-15 72h post-aSAH in six neurovascular centers underwent neuropsychological (Montreal Cognitive Assessment; MoCA), neurological (National Institutes of Health Stroke Scale; NIHSS), headache (visual analog scale; VAS), disability (modified Rankin Scale; mRS) and health-related quality of life (EuroQol Five Dimensions; EQ5D) assessments within 72h, 14 days and three months after aSAH. We compared these multidimensional outcomes and complications for clipped and coiled patients.
RESULTS
Of 126 patients (mean age 53.8 years; 63.9 % female), 84 were coiled and 42 clipped. MoCA scores for clipped vs coiled patients were 23(7) vs 23(8; p = 0.250), 25(8) vs 28(5; p = 0.346), and 27(4) vs 28(5; p = 0.481). Normal cognition (MoCA ≥26) was achieved within 72h by 28.6 % of coiled and 40.5 % of clipped patients (p = 0.179). Complication rates were similar, though surgical patients had higher intraprocedural rupture rates (p = 0.027). Clipped patients reported higher headaches at three months (p = 0.013), while NIHSS, mRS and EQ5D showed no differences.
DISCUSSION AND CONCLUSION
After interdisciplinary selection of the most appropriate treatment, similar favorable outcomes can be achieved in alert aSAH patients.
引言
尽管脑动脉瘤治疗取得了进展，但详细的治疗结果信息仍然有限。我们比较了通过多学科委员会讨论做出个体化决策后接受夹闭或血管内栓塞治疗的清醒动脉瘤性蛛网膜下腔出血（aSAH）患者（格拉斯哥昏迷量表评分≥13分）的并发症和多维度治疗结果。
研究问题
对于清醒aSAH患者，当治疗选择个体化时，夹闭和血管内栓塞治疗在多维度治疗结果上是否存在显著差异？
材料与方法
在前瞻性的MoCA-DCI研究（ClinicalTrials.gov标识符：NCT03032471）中，六个神经血管中心的aSAH患者在发病72小时后格拉斯哥昏迷量表评分为13-15分，在aSAH后72小时、14天和三个月内接受了神经心理学（蒙特利尔认知评估量表；MoCA）、神经学（美国国立卫生研究院卒中量表；NIHSS）、头痛（视觉模拟量表；VAS）、残疾（改良Rankin量表；mRS）和健康相关生活质量（欧洲五维健康量表；EQ5D）评估。我们比较了接受夹闭和血管内栓塞治疗患者的这些多维度治疗结果和并发症。
结果
126例患者（平均年龄53.8岁；63.9%为女性）中，84例行血管内栓塞治疗，42例行夹闭治疗。夹闭组与血管内栓塞组患者的MoCA评分分别为23（7）分对23（8）分；p = 0.250）、25（8）分对28（5）分；p = 0.346）和27（4）分对28（5）分；p = 0.481）。72小时内，28.6%的血管内栓塞治疗患者和40.5%的夹闭治疗患者达到正常认知（MoCA≥26分）（p = 0.179）。并发症发生率相似，尽管手术患者术中破裂率较高（p = 0.027）。夹闭治疗患者在三个月时报告头痛更严重（p = 0.013），而NIHSS、mRS和EQ5D评分无差异。
讨论与结论
在跨学科选择最合适的治疗方法后，清醒aSAH患者可获得相似的良好治疗结果。
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