Comparative analysis of surgical and endovascular aneurysm repair in subarachnoid hemorrhage: a single-center study with 1,171 patients

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-09-13 DOI:10.1007/s00701-025-06670-w

Per Kristian Eide, Wilhelm Sorteberg, Are H. Pripp, Pål A. Rønning, Angelika G. Sorteberg

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Abstract

Background

To compare surgical and endovascular therapy (EVT) approaches to aneurysm repair in all aneurysmal subarachnoid hemorrhage (aSAH) patients treated within our institution over a 12-year period from 2011 to 2022.

Methods

The study comprised a retrospective analysis of prospectively collected data extracted from a hospital quality registry that we established in 2011, containing comprehensive information about all patients treated for aSAH. We included SAH patients within the institution's catchment area who underwent surgical or endovascular aneurysm repair. Exclusion criteria involved patients from external regions, those treated at other institutions, no aneurysm repair performed, or instances undergoing a combination of surgery and EVT. Pretreatment data encompassed the clinical condition at admission, comorbidity, radiological details, aneurysm characteristics, and duration between the bleed and aneurysm repair. Mortality was primary outcome measure; secondary outcome included modified Rankin Score after approximately six months.

Results

The study encompassed 1,171 patients (65% women and 35% men) undergoing aneurysm repair from 2011 to 2022. Admission data revealed 31.1% in Hunt-Hess grade 4–5. Surgical repair was performed in 573 (48.9%) patients, and EVT in 598 (51.1%) patients. Pretreatment information was comparable for both groups. Kaplan–Meier survival curves demonstrated lower mortality in the surgical than the EVT group (P = 0.023; Log-rank test) over the 12-year period. The 1-year, 5-year, and 10-year mortality rates were 12.4%, 19.5%, and 27.7% for the surgery group, and 18.7%, 25.2%, and 31.7% for the EVT group, respectively. Modified Rankin Score was worse for EVT. There was lower mortality in surgical than EVT groups in patients treated for anterior communicating artery (ACOM, n = 420) and posterior communicating artery (PCOM, n = 177) aneurysms. Shorter time to aneurysm repair and more extensive cerebrospinal fluid (CSF) drainage characterized the surgery group.

Conclusions

Mortality was lower in surgical patients. Plausible explanations are the maintenance of surgical skills and prompt reduction of intracranial pressure.

查看原文本刊更多论文

1171例蛛网膜下腔出血的单中心研究：手术与血管内动脉瘤修复的比较分析

研究背景：比较2011年至2022年12年间在我院治疗的所有动脉瘤性蛛网膜下腔出血（aSAH）患者的手术和血管内治疗（EVT）方法。方法：本研究对前瞻性收集的数据进行回顾性分析，这些数据提取自我们于2011年建立的医院质量登记处，其中包含所有接受aSAH治疗的患者的综合信息。我们纳入了该机构辖区内接受手术或血管内动脉瘤修复的SAH患者。排除标准包括来自外部地区的患者，在其他机构治疗的患者，未进行动脉瘤修复的患者，或接受手术和EVT联合治疗的患者。预处理数据包括入院时的临床情况、合并症、影像学细节、动脉瘤特征以及出血至动脉瘤修复之间的时间。死亡率是主要结局指标；次要结局包括大约6个月后的改良Rankin评分。该研究包括1171例患者（65%的女性和35%的男性）在2011年至2022年间接受动脉瘤修复。入院数据显示，亨特-赫斯4-5级占31.1%。573例（48.9%）患者行手术修复，598例（51.1%）患者行EVT。两组的预处理信息具有可比性。Kaplan-Meier生存曲线显示，手术组12年期间的死亡率低于EVT组（P = 0.023； Log-rank检验）。手术组1年、5年和10年死亡率分别为12.4%、19.5%和27.7%，EVT组分别为18.7%、25.2%和31.7%。EVT的改良Rankin评分更差。前交通动脉（ACOM, n = 420）和后交通动脉（PCOM, n = 177）动脉瘤手术死亡率低于EVT组。手术组动脉瘤修复时间较短，脑脊液引流范围较广。结论手术患者死亡率较低。合理的解释是手术技巧的维持和颅内压的迅速降低。

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

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.