颅内动脉瘤破裂血管内或显微手术闭塞后的多维预后——瑞士一项前瞻性多中心研究的比较分析

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2025.104262

Vincens Kälin , Martin N. Stienen , Olivia Zindel-Geisseler , Noemi Dannecker , Yannick Rothacher , Ladina Schlosser , Julia Velz , Martina Sebök , Noemi Eggenberger , Adrien May , Philippe Bijlenga , Ursula Guerra-Lopez , Rodolfo Maduri , Daniele Starnoni , Valérie Beaud , Alessio Chiappini , Thomas Robert , Sara Bonasia , Stefania Rossi , Johannes Goldberg , Luca Regli

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引用次数: 0

摘要

尽管脑动脉瘤治疗取得了进展，但关于详细结果的信息仍然有限。我们比较了危重性动脉瘤性蛛网膜下腔出血（aSAH）患者（GCS≥13）在通过多学科委员会讨论做出个性化决定后接受夹闭或卷取的并发症和多维结局。研究问题：当治疗选择个体化时，危重性aSAH患者的夹持和盘绕治疗在多维结果上是否存在显著差异？材料和方法在前瞻性MoCA-DCI研究（ClinicalTrials.gov标识：NCT03032471）中，6个神经血管中心asah后72小时GCS为13-15的患者接受了神经心理学(蒙特利尔认知评估；MoCA)，神经学(美国国立卫生研究院卒中量表；NIHSS)，头痛(视觉模拟量表；VAS)、残疾(改良Rankin量表；mRS)和与健康有关的生活质量(EuroQol五个维度；在aSAH后72小时、14天和3个月内进行EQ5D评估。我们比较了夹持和盘绕患者的这些多维结果和并发症。结果126例患者，平均年龄53.8岁；63.9%为女性)，84例为盘状，42例为夹状。夹持和盘绕患者的MoCA评分分别为23(7)和23(8)；P = 0.250), 25(8) vs 28(5)；P = 0.346), 27(4) vs 28(5)；p = 0.481)。28.6%的卷曲组和40.5%的夹持组在72h内达到正常认知（MoCA≥26）（p = 0.179）。并发症发生率相似，但手术患者术中破裂率较高（p = 0.027）。夹头患者在3个月时头痛发生率较高（p = 0.013），而NIHSS、mRS和EQ5D无差异。讨论与结论经跨学科选择最合适的治疗方法后，危重性aSAH患者也可获得类似的良好结局。

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Multidimensional outcome after endovascular or microsurgical occlusion of ruptured intracranial aneurysms – Comparative analysis of a prospective Swiss multicenter study

Introduction

Despite advances in cerebral aneurysm treatment, information on detailed outcomes remains limited. We compared complications and multidimensional outcomes in alert aneurysmal subarachnoid hemorrhage (aSAH) patients (GCS ≥13) who received clipping or coiling after individualized decisions were made through multidisciplinary board discussions.

Research question

Are there significant differences in multidimensional outcomes between clipping and coiling treatments for alert aSAH patients when treatment selection is individualized?

Material and methods

Within the prospective MoCA-DCI study (ClinicalTrials.gov identifier: NCT03032471), patients with a GCS of 13–15 72h post-aSAH in six neurovascular centers underwent neuropsychological (Montreal Cognitive Assessment; MoCA), neurological (National Institutes of Health Stroke Scale; NIHSS), headache (visual analog scale; VAS), disability (modified Rankin Scale; mRS) and health-related quality of life (EuroQol Five Dimensions; EQ5D) assessments within 72h, 14 days and three months after aSAH. We compared these multidimensional outcomes and complications for clipped and coiled patients.

Results

Of 126 patients (mean age 53.8 years; 63.9 % female), 84 were coiled and 42 clipped. MoCA scores for clipped vs coiled patients were 23(7) vs 23(8; p = 0.250), 25(8) vs 28(5; p = 0.346), and 27(4) vs 28(5; p = 0.481). Normal cognition (MoCA ≥26) was achieved within 72h by 28.6 % of coiled and 40.5 % of clipped patients (p = 0.179). Complication rates were similar, though surgical patients had higher intraprocedural rupture rates (p = 0.027). Clipped patients reported higher headaches at three months (p = 0.013), while NIHSS, mRS and EQ5D showed no differences.