Endovascular coiling vs microsurgical clipping for unruptured aneurysms of the anterior circulation: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-25 DOI:10.1016/j.jocn.2025.111419

Anderson Matheus Pereira da Silva , Mariana Leticia de Bastos Maximiano , Lucas Silva Cabeça , Anderson Silva Corin , Ocilio de Deus , Ariane Barros Mesquita Cunha , Gabrielle Silva Vieira , Julia Oliveira Franco , Eberval Gadelha Figueiredo , Gustavo Sousa Noleto

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引用次数: 0

Abstract

Background

Despite extensive research, the optimal approach for treating unruptured anterior circulation aneurysms (UACs) remains uncertain because of heterogeneous findings and limited robust data. To compare the outcomes of microsurgical clipping (MSC) with endovascular treatment (EVT) for UACs.

Methods

A systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to December 2024. Eligible studies included patients with UCAs treated with MSC or EVT. The primary outcomes were functional outcomes (mRS 0–2), recurrence rates, procedural complications, and mortality. Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated using a random-effects model. The Mantel-Haenszel method with a random-effects model was employed for the meta-analyses. All statistical analyses were conducted using R version 4.4.2.

Results

The analysis included data from 17 studies with 7,176 patients, of whom 3,810 (53.1 %) underwent EVT and 3,366 (46.9 %) received MSC. Complete occlusion rates were higher with MSC (OR 0.29; 95 % CI 0.15–0.56; p < 0.01), while procedural success also favored MSC (OR 0.42; 95 % CI 0.23–0.78; p < 0.01). Complications were less frequent with EVT, including serious adverse events (OR 0.53; 95 % CI 0.33–0.84; p < 0.01), vasospasm (OR 0.63; 95 % CI 0.44–0.89; p = 0.04), and thrombotic events (OR 2.23; 95 % CI 0.84–5.96; p = 0.12). However, EVT was associated with higher rates of residual aneurysms (OR 4.57; 95 % CI 1.75–11.97; p = 0.95), residual neck (OR 5.31; 95 % CI 2.81–10.02; p = 0.22), and need for retreatment (OR 5.65; 95 % CI 2.35–13.54; p = 0.99).

Conclusion

EVT offers advantages in reducing perioperative complications, while MSC provides greater long-term durability. Considering comparable functional outcomes and mortality, individualized treatment decisions should be based on patient profiles, aneurysm characteristics.

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血管内盘绕与显微手术夹持治疗前循环未破裂动脉瘤：系统回顾和荟萃分析

尽管进行了广泛的研究，但由于研究结果不一致和可靠的数据有限，治疗未破裂前循环动脉瘤（UACs）的最佳方法仍然不确定。目的比较显微外科夹持（MSC）与血管内治疗（EVT）治疗UACs的效果。方法系统检索截至2024年12月的PubMed、Embase、Cochrane Library、Web of Science、Scopus等数据库。符合条件的研究包括接受MSC或EVT治疗的uca患者。主要结局是功能结局（mRS 0-2）、复发率、手术并发症和死亡率。使用随机效应模型计算95%置信区间（CI）的比值比（OR）。meta分析采用随机效应模型的Mantel-Haenszel方法。所有统计分析均采用R版本4.4.2进行。结果分析包括17项研究的数据，7176例患者，其中3810例（53.1%）接受EVT， 3366例（46.9%）接受MSC。骨髓间充质干细胞的完全闭塞率更高(OR 0.29；95% ci 0.15-0.56；p & lt;0.01)，而手术成功也有利于MSC (OR 0.42；95% ci 0.23-0.78；p & lt;0.01)。EVT并发症发生率较低，包括严重不良事件(OR 0.53；95% ci 0.33-0.84；p & lt;0.01)，血管痉挛(OR 0.63；95% ci 0.44-0.89；p = 0.04)，血栓形成事件(OR 2.23；95% ci 0.84-5.96；p = 0.12)。然而，EVT与较高的残留动脉瘤率相关(OR 4.57；95% ci 1.75-11.97；p = 0.95)，残颈(OR 5.31；95% ci 2.81-10.02；p = 0.22)，需要再治疗(OR 5.65；95% ci 2.35-13.54；p = 0.99)。结论evt具有减少围手术期并发症的优势，而MSC具有更大的长期耐久性。考虑到可比较的功能结果和死亡率，个体化治疗决策应基于患者概况和动脉瘤特征。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.