Ye Zhiqiang, Tang Huanyu, Xia Shiming, Tang Xiaoping
Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College Nanchong 637000, Sichuan, The People's Republic of China.
Am J Transl Res. 2025 May 15;17(5):3322-3332. doi: 10.62347/AEWG1973. eCollection 2025.
To evaluate the short-term efficacy and rebleeding risk of vascular intervention in patients with aneurysmal subarachnoid hemorrhage (aSAH).
This retrospective study included 98 aSAH patients treated between August 2020 and May 2023. Based on the treatment method, patients were divided into an interventional group (n = 50, treated with endovascular embolization) and a craniotomy group (n = 48, treated with microsurgical clipping). Surgical parameters, clinical outcomes, immune markers, prognosis scores, cognitive function, and safety were compared using t-tests or chi-square tests. Binary logistic regression identified independent risk factors for clinical outcomes and rebleeding.
The interventional group showed significantly less intraoperative blood loss, shorter hospital stays, and shorter operative times compared to the craniotomy group (all < 0.05). Clinical outcomes and Glasgow Outcome Scale scores were better in the interventional group (all P < 0.05). At 3 days and 3 months post-surgery, immune markers (IgG, IgA, IgM) were significantly higher in the interventional group (all P < 0.05). Additionally, MMSE scores at 3 days post-surgery were higher, and the incidence of postoperative cognitive dysfunction within 3 months was lower (both P < 0.05). The complication rate was significantly lower in the interventional group (12.00% vs. 37.50%, P < 0.05). Preoperative Hunt-Hess grade, surgical approach, age, and postoperative complications were identified as independent risk factors for prognosis (all P < 0.05), while surgical approach, age, and Hunt-Hess grade were risk factors for rebleeding (all P < 0.05).
Vascular intervention provides superior short-term efficacy in aSAH patients, with faster recovery, reduced surgical trauma, and better clinical outcomes compared to craniotomy. Monitoring should be intensified for older patients and those with higher preoperative Hunt-Hess grades to minimize the risks of poor prognosis and rebleeding.
评估血管内介入治疗对动脉瘤性蛛网膜下腔出血（aSAH）患者的短期疗效及再出血风险。
本回顾性研究纳入了2020年8月至2023年5月期间接受治疗的98例aSAH患者。根据治疗方法，将患者分为介入组（n = 50，接受血管内栓塞治疗）和开颅手术组（n = 48，接受显微手术夹闭治疗）。采用t检验或卡方检验比较手术参数、临床结局、免疫标志物、预后评分、认知功能和安全性。二元逻辑回归分析确定临床结局和再出血的独立危险因素。
与开颅手术组相比，介入组术中失血量明显减少，住院时间和手术时间更短（均P < 0.05）。介入组的临床结局和格拉斯哥预后评分更好（均P < 0.05）。术后3天和3个月时，介入组的免疫标志物（IgG、IgA、IgM）明显更高（均P < 0.05）。此外，术后3天的简易精神状态检查表（MMSE）评分更高，3个月内术后认知功能障碍的发生率更低（均P < 0.05）。介入组的并发症发生率明显更低（12.00% 对37.50%，P < 0.05）。术前Hunt-Hess分级、手术入路、年龄和术后并发症被确定为预后的独立危险因素（均P < 0.05），而手术入路、年龄和Hunt-Hess分级是再出血的危险因素（均P < 0.05）。
与开颅手术相比，血管内介入治疗为aSAH患者提供了更优的短期疗效，恢复更快，手术创伤更小，临床结局更好。对于老年患者和术前Hunt-Hess分级较高的患者，应加强监测，以尽量降低预后不良和再出血的风险。
