Therapeutic strategies and prognostic factors of patients with ruptured intracranial aneurysms based on propensity score matching analysis:a single-center retrospective cohort study of 1 572 cases

SUN Qi; WANG Yi; BIAN Shi-chun; AN Xue-feng; QIN Jie; WEI Ke; CAI Yan-chao; LEI Jie; YANG Ming; HUANG He; MA Lian-ting

doi:10.13798/j.issn.1009-153X.2023.12.001

Abstract：Objective To explore the efficacy of microsurgical clipping and endovascular embolization for patients with ruptured intracranial aneurysms(RIA)and the RIA patients'prognotic factors,in order to provide more reference for the treatment of RIA.Methods The clinical data of 1 572 patients with RIA,of whom 407 patients underwent microsurgical clipping(clipping group)and 1165 patients underwent endovascular embolization(embolization group),from June 2013 to June 2023 were retrospectively analyzed.The prognoses of these patients were evaluated by the GOS score at discharge,with a GOS score of 1～3 as poor prognosis and a GOS score of 4～5 as good prognosis.Results The rate of good prognosis in the embolization group(88.3％)was significantly higher than that(75.4％)in the clipping group(P＜0.05),and the length of hospital stay in the embolization group(14 d;IQR 11～18 d)was significantly shorter than that(16 d;IQR 13～25 d)in the clipping group(P＜0.05).However,there were significant differences in preoperative Hunt-Hess grade,intracranial hematoma and aneurysm site between the two groups(P＜0.05).After propensity score matching(PSM)analysis,336 patients were included in each of the two groups.The PSM analysis results showed that there was no significant difference in the rate of good prognosis at discharge between the embolization group(81.0％)and the clipping group(81.8％;P＞0.05),but the length of hospital stay in the embolization group(10 d;IQR 8～11 d)was significantly shorter than that(16 d;IQR 13～22 d)in the clipping group(P＜0.05).Multivariate logistic regression analysis showed that age ≥60 years,onset time＞72 h,intracranial hematoma and preoperative Hunt-Hess grade Ⅳ～Ⅴ were independent risk factors for poor prognoses of patients with RIA(P＜0.05).In the clipping group,307 patients were followed up,and the recurrence rate was 1.9％.In the embolization group,1 029 patients were followed up,and the recurrence rate was 7.3％.The recurrence rate in the clipping group was significantly lower than that in the embolization group(P＜0.05).After PSM analysis,275 patients were included in each group,and the recurrence rate of clipping group(2.2％)was significantly lower than that(6.6％)of the embolization group(P＜0.05).Conclusions Both microsurgical clipping and endovascular embolization have good efficacy for patients with RIA.and embolization has a short hospital stay and a high recurrence rate.In clinic,the selection should be individualized according to the patient's condition.Patients'age,onset time,intracranial hematoma and Hunt-Hess grade are independent prognostic factors of patients with RIA.