Microsurgical Treatment versus Endovascular Treatment for Ruptured Intracranial Aneurysms in Elderly Patients: A Multicenter Study in Northern China.

IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY
Yikuan Gao, Xiuhu An, Bangyue Wang, Shunde Liu, Wuqiang Jiang, Xiangping Zhong, Lijin He, Xinyu Yang
{"title":"Microsurgical Treatment versus Endovascular Treatment for Ruptured Intracranial Aneurysms in Elderly Patients: A Multicenter Study in Northern China.","authors":"Yikuan Gao, Xiuhu An, Bangyue Wang, Shunde Liu, Wuqiang Jiang, Xiangping Zhong, Lijin He, Xinyu Yang","doi":"10.1159/000544079","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Management of ruptured intracranial aneurysms (RIAs) in elderly patients remains a major challenge in the treatment of cerebrovascular diseases. This study aims to provide a comprehensive analysis of the impact of microsurgical treatment (MST) and endovascular treatment (EVT) on the outcomes of elderly patients with RIAs in northern China.</p><p><strong>Methods: </strong>We consecutively enrolled elderly patients with RIAs who underwent surgery in the Chinese Multicenter Cerebral Aneurysm Database (CMAD) from January 2017 to December 2020. In this study, in-hospital complications, survival, and functional outcomes were compared between MST and EVT after 1:1 propensity score matching (PSM). Kaplan-Meier survival analyses and Cox proportional hazards modeling identified factors associated with mortality in both groups. Logistic regression analyses identified 2-year survival-dependent risk factors, and subgroup analyses were conducted for key strata.</p><p><strong>Results: </strong>744 elderly patients with RIAs were enrolled in the study. 219 patients with MST after PSM were matched with 219 patients with EVT. Compared to EVT, MST had a higher 2-year mortality rate (32.8% vs. 20.5%, p=0.002), higher incidence of adverse discharge outcomes (48.4% vs. 32.4%, p=0.001), longer length of stay (LOS) (16 (12-24) vs. 15 (10-23), p=0.049), pneumonia (MST: 31.1%; EVT: 21.9%, p=0.030), and intracranial infection (9.6% vs. 2.7%, p=0.005). However, there was no difference in the 2-year survival-dependent outcome (22.7% vs 23.2%, p=0.924). Differences in risk factors for mortality and 2-year survival-dependent outcomes were observed between the MST and EVT groups in the elderly population. The negative association of EVT with risk of mortality was consistent across specific subgroups.</p><p><strong>Conclusion: </strong>Elderly patients with RIAs who underwent EVT were significantly better than the MST group in terms of short-term functional outcomes, in-hospital complications, long-term survival, and LOS. However, there were no differences in the 2-year survival-dependent outcomes.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-22"},"PeriodicalIF":3.2000,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroepidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000544079","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Management of ruptured intracranial aneurysms (RIAs) in elderly patients remains a major challenge in the treatment of cerebrovascular diseases. This study aims to provide a comprehensive analysis of the impact of microsurgical treatment (MST) and endovascular treatment (EVT) on the outcomes of elderly patients with RIAs in northern China.

Methods: We consecutively enrolled elderly patients with RIAs who underwent surgery in the Chinese Multicenter Cerebral Aneurysm Database (CMAD) from January 2017 to December 2020. In this study, in-hospital complications, survival, and functional outcomes were compared between MST and EVT after 1:1 propensity score matching (PSM). Kaplan-Meier survival analyses and Cox proportional hazards modeling identified factors associated with mortality in both groups. Logistic regression analyses identified 2-year survival-dependent risk factors, and subgroup analyses were conducted for key strata.

Results: 744 elderly patients with RIAs were enrolled in the study. 219 patients with MST after PSM were matched with 219 patients with EVT. Compared to EVT, MST had a higher 2-year mortality rate (32.8% vs. 20.5%, p=0.002), higher incidence of adverse discharge outcomes (48.4% vs. 32.4%, p=0.001), longer length of stay (LOS) (16 (12-24) vs. 15 (10-23), p=0.049), pneumonia (MST: 31.1%; EVT: 21.9%, p=0.030), and intracranial infection (9.6% vs. 2.7%, p=0.005). However, there was no difference in the 2-year survival-dependent outcome (22.7% vs 23.2%, p=0.924). Differences in risk factors for mortality and 2-year survival-dependent outcomes were observed between the MST and EVT groups in the elderly population. The negative association of EVT with risk of mortality was consistent across specific subgroups.

Conclusion: Elderly patients with RIAs who underwent EVT were significantly better than the MST group in terms of short-term functional outcomes, in-hospital complications, long-term survival, and LOS. However, there were no differences in the 2-year survival-dependent outcomes.

求助全文
约1分钟内获得全文 求助全文
来源期刊
Neuroepidemiology
Neuroepidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
9.90
自引率
1.80%
发文量
49
审稿时长
6-12 weeks
期刊介绍: ''Neuroepidemiology'' is the only internationally recognised peer-reviewed periodical devoted to descriptive, analytical and experimental studies in the epidemiology of neurologic disease. The scope of the journal expands the boundaries of traditional clinical neurology by providing new insights regarding the etiology, determinants, distribution, management and prevention of diseases of the nervous system.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信