Treatment Landscape of Intracranial Aneurysms in Eastern China: A Propensity-Matched Analysis of Technique Adoption and Outcomes (2018–2022)

Abstract

Objective

To analyze treatment trends and outcomes for intracranial aneurysms (IAs) in Eastern China, comparing microsurgical clipping (SC) and endovascular coiling (EC), and exploring clinical and socioeconomic factors influencing treatment decisions.

Methods

A multicenter retrospective study of 2720 patients with 2811 aneurysms treated between 2018 and 2022 was conducted. Propensity score matching compared surgical procedures and clinical outcomes, while multivariable logistic regression identified determinants of treatment choice. Annual growth rates were calculated using compound annual growth rate.

Results

Of 1281 patients with ruptured IAs, 533 underwent SC and 748 received EC. For 1439 patients with unruptured IAs (UIAs), 1295 (90%) were treated with EC. Post-propensity score matching analysis showed EC had shorter operative times, fewer complications, but higher costs and recurrence risks. EC was preferred for UIAs and patients with higher Glasgow Coma Scale scores, while SC was chosen for complex aneurysms and severe clinical cases. Notably, EC adoption increased significantly, with a compound annual growth rate of 16.3% for ruptured IAs and 19.1% for UIAs, highlighting a shift toward technological preference.

Conclusions

This is the first multicenter study on IA treatment in Eastern China, integrating clinical outcomes with socioeconomic factors. Findings suggest EC is increasingly favored, particularly for UIAs, but SC remains essential for complex cases. Both approaches offer distinct advantages and should be considered in the context of clinical efficacy and economic realities.