破裂大脑中动脉瘤多学科会诊治疗方案疗效评价：单中心261例回顾性分析

目的 比较多学科会诊确定破裂大脑中动脉瘤患者行介入栓塞或手术夹闭动脉瘤的治疗效果。 

Evaluation of Multidisciplinary Treatment of Ruptured Middle Cerebral Artery Aneurysms: A Single-center Retrospective Analysis

Objective Different treatment strategies for ruptured intracranial aneurysms have been recently
developed, and multidisciplinary treatment approaches have been applied in clinical practice. This
study aimed to evaluate the outcome of multidisciplinary treatment for ruptured middle cerebral
artery (MCA) aneurysms with surgical clipping or endovascular coil embolization.
Methods A retrospective analysis of clinical data of patients with ruptured MCA aneurysms
treated by clipping or coil embolization determined by consultation were conducted. The outcome
measurement included that perioperative ischemic stroke and the complete occlusion rate after the
first treatment; the complete occlusion rate, permanent sequelae of ischemic stroke arising from
surgical procedures, retreatment, rebleeding and mortality after the whole follow-up. The average
period of follow-up was 17.9 months.
Results A total of 261 eligible patients were included in this study, with endovascular coil
embolization for 107 cases and surgical clipping for 154 cases. Periprocedural ischemic stroke
occurred in 28 patients (10.72%), and 24 cases (0.91%) of them had permanent sequelae associated
with ischemic stroke. The complete aneurysm occlusion after the first treatment occurred in 80 patients
(74.7%) with endovascular coil embolization, and in 150 cases (97.4%) with surgical clipping. Afterthe completion of follow-up, the complete occlusion occurred in 179 cases (82.9%). 9 cases (0.34%)
needed retreatment, 5 cases (0.19%) occurred rebleeding, and 5 cases (0.19%) died. The procedure
related ischemic stroke incidence (6.5% vs 16.8%, P =0.008) and permanent sequelae of this kind of
stroke (5.8% vs 14.0%, P =0.020) were higher in coil embolization group than that in clipping group.
The complete occlusion rate of aneurysms immediately after surgery (97.4% vs 74.7%, P <0.001) and
after the follow-up (95.1% vs 65.2%, P <0.001) were higher in surgical clipping group than that in coil
embolization group. No patient needed retreatment in clipping group, while 9 ones needed retreatment
in coil embolization group. There were no significant difference in rebleeding (0.6% vs 3.7%) and
mortality (1.3% vs 2.8%) between the two groups.
Conclusion The multidisciplinary treatment approaches for ruptured MCA aneurysms can
achieve a better outcome. Surgical clipping for ruptured MCA aneurysms showed a lower rate of
complications and a higher occlusion rate than endovascular coil embolization.