Efficacy analysis of different surgical approaches for the treatment of ruptured intracranial aneurysms in various locations of the anterior circulation
Liu Ling
Zhang Jidong
Abstract：Objective To compare the efficacy of early microsurgical clipping and endovascular embolization in the treatment of ruptured intracranial aneurysms at different locations in the anterior circulation.Methods The clinical data of 280 patients with ruptured anterior circulation aneurysms were analyzed retrospectively.Based on the treatment plan,the patients were divided into a clipping group(treated with microsurgical clipping,n=142)and an embolization group(treated with endovascular embolization,n=138).The propensity score matching(PSM)was performed with a caliper value of 0.25 and a 1:1 matching ratio,120 pairs of patients with comparable baseline data were selected.Baseline data,perioperative indicators,complications,and prognosis were compared between the two groups.Stratified analysis was then performed on statistically significant indicators according to aneurysm location:anterior communicating artery,posterior communicating artery,and middle cerebral artery.Results The clipping group had longer operation times,greater intraoperative blood loss,and longer hospital stays for aneurysms in the anterior communicating artery,posterior communicating artery,and middle cerebral artery compared to the embolization group,with statistically significant differences(all P<0.001).There was no statistically significant difference in complications between the clipping and embolization groups(P>0.05).The residual rates of aneurysmal neck at one year postoperatively were 7.50%and 47.50%in the clipping and embolization groups,respectively,with rates of 2.50%and 15.00%for anterior communicating artery aneurysms,2.50%and 15.00%for posterior communicating artery aneurysms,and 2.50%and 17.50%for middle cerebral artery aneurysms,respectively,all showing statistically significant differences(all P<0.05).The rates of good prognosis at one year postoperatively were 82.50%and 90.00%in the clipping and embolization groups,respectively,with no statistically significant difference(P>0.05).The aneurysm recurrence rates at one year postoperatively were 6.25%(3/48)and 26.67%(12/45)for anterior communicating artery aneurysms,7.14%(3/42)and 26.67%(12/45)for posterior communicating artery aneurysms,and 0.00%(0/30)and 30.00%(9/30)for middle cerebral artery aneurysms in the two groups,respectively,with no statistically significant differences(all P>0.05).Conclusions For anterior circulation ruptured intracranial aneurysms at different locations,microsurgical clipping can reduce the rate of aneurysm neck residue and is associated with a lower recurrence rate,while endovascular embolization facilitates faster patient recovery(with superior perioperative indicators).Both surgical approaches can effectively improve patient prognosis.
Keywords：intracranial aneurysmrupturedsubarachnoid hemorrhagemicrosurgical clippingendovascular embolization
Publication Date：2025-08-20
Online Publishing Date：2025-08-29(First online date of this platform, not the publication date of the document)
Pages：6( 474-479 )