Abstract：
To compare the safety and efficacy of clipping and coiling in patients with ruptured anterior circulation aneurysms. A systematic search of four databases (PubMed, Web of Science, Cochrane Library, and Embase) was conducted to identify comparative articles on endovascular coiling and surgical clipping in patients with ruptured anterior circulation aneurysms. Meta-analyses were conducted using random-effects models. Nineteen studies, including 1983 patients, were included. The meta-analysis showed that neurosurgical clipping was associated with a lower incidence of retreatment (OR:0.28, 95% CI (0.11, 0.70), P = 0.006) than endovascular coiling, which seemed to be a result of incomplete occlusion (OR:0.22, 95% CI (0.11, 0.45), P < 0.001). Neurosurgical clipping was associated with lower mortality (OR:0.45, 95% CI (0.25, 0.82), P = 0.009) at short-term follow-up than endovascular coiling. However, neurosurgical clipping showed a higher incidence of ischemic infarction (OR:2.28, 95% CI (1.44, 3.63), P < 0.001) and a longer length of stay (LOS) (WMD:6.12, 95% CI (4.19, 8.04), P < 0.001) after surgery than endovascular coiling. Furthermore, the pooled results showed no statistically significant differences between the two groups regarding poor outcome, long-term mortality, rebleeding, vasospasm, and hydrocephalus. Evidence from this systematic review illustrates that neurosurgical clipping may be superior to endovascular coiling for ruptured anterior circulation aneurysms. Large-scale RCTs should be conducted to verify these outcomes and provide results according to patient status.
摘要：
比较前循环动脉瘤破裂患者夹闭和卷绕的安全性和疗效。对四个数据库的系统搜索(PubMed，WebofScience,科克伦图书馆,和Embase）进行了研究，以确定前循环动脉瘤破裂患者的血管内线圈和手术夹闭的比较文章。采用随机效应模型进行Meta分析。十九项研究，包括1983名患者,包括在内。荟萃分析显示，神经外科夹闭与较低的再治疗发生率相关（OR：0.28，95％CI（0.11，0.70），P=0.006）比血管内卷绕，这似乎是不完全闭塞的结果(OR：0.22，95%CI(0.11，0.45)，P<0.001)。神经外科手术夹闭与较低的死亡率相关(OR:0.45,95%CI(0.25,0.82),短期随访时P=0.009）比血管内线圈。然而,神经外科夹闭显示缺血性梗死发生率较高(OR:2.28,95%CI(1.44,3.63),P<0.001）和更长的住院时间（LOS）（WMD：6.12，95％CI（4.19，8.04），P<0.001)术后比腔内盘绕。此外，汇总结果显示，两组之间在不良结局方面没有统计学上的显着差异，长期死亡率，再出血,血管痉挛,和脑积水.来自此系统评价的证据表明，对于破裂的前循环动脉瘤，神经外科手术夹闭可能优于血管内卷绕。应进行大规模RCT以验证这些结果，并根据患者状况提供结果。
