目的:虽然随机对照试验比较了手术和血管内治疗颅内动脉瘤,在前交通动脉(ACoA)动脉瘤治疗的亚组分析方面,文献很少.本系统评价和荟萃分析旨在比较ACoA动脉瘤的手术和血管内治疗。
方法:Medline,PubMed,和Embase从成立到2022年12月12日进行了搜索。主要结果是治疗后改良Rankin量表(mRS)>2和死亡率。次要结果是动脉瘤闭塞,再治疗和复发,再出血,技术故障,血管破裂,动脉瘤性蛛网膜下腔出血相关脑积水,症状性血管痉挛,和中风。
结果:18项研究产生了2368名患者,其中1196例(50.5%)和1172例(49.4%)患者接受了手术和血管内治疗,分别。死亡率的比值比(OR)总体相似(OR=0.92[0.63-1.37],P=0.69),破裂(OR=0.92[0.62-1.36],P=0.66),和未破裂的队列(OR=1.58[0.06-39.60],P=0.78)。mRS>2的OR总体相似(OR=0.75[0.50-1.13],P=0.17),破裂(OR=0.77[0.49-1.20],P=0.25),和未破裂的队列(OR=0.64[0.21-1.96],P=0.44)。手术后闭塞的OR较高(OR=2.52[1.49-4.27],P=0.0008)和破裂队列(OR=2.61[1.33-5.10],P=0.005)和未破裂组(OR=3.46[1.30-9.20],P=0.01)。手术后再治疗的OR降低(OR=0.37[0.17-0.76],P=0.007)和破裂队列(OR=0.31[0.11-0.89],P=0.03),认为未破裂组相似(OR=0.51[0.08-3.03],P=0.46)。手术后复发的OR降低(OR=0.22[0.10,0.47],P=0.0001),破裂(OR=0.16[0.03,0.90],P=0.04),和混合(未)破裂的队列(OR=0.22[0.09-0.53],P=0.0009)。破裂组再出血的OR值相似(OR=0.66[0.29~1.52],P=0.33)。其他结果的OR相似。
结论:ACoA动脉瘤可以通过手术或血管内治疗来安全治疗,尽管显微手术夹闭显示较高的闭塞率和较低的再治疗和复发率。
Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic
review and meta-analysis sought to compare surgical versus endovascular treatment for ACoA aneurysms.
Medline, PubMed, and Embase were searched from inception to December 12, 2022. Primary outcomes were post-treatment modified Rankin Scale (mRS) >2 and mortality. Secondary outcomes were aneurysm obliteration, retreatment and recurrence, rebleeding, technical failure, vessel rupture, aneurysmal subarachnoid hemorrhage-related hydrocephalus, symptomatic vasospasm, and stroke.
Eighteen studies yielded 2368 patients, from which 1196 (50.5%) and 1172 (49.4%) patients underwent surgery and endovascular treatment, respectively. The odds ratio (OR) of mortality was similar in total (OR = 0.92 [0.63-1.37], P = 0.69), ruptured (OR = 0.92 [0.62-1.36], P = 0.66), and unruptured cohorts (OR = 1.58 [0.06-39.60], P = 0.78). The OR of mRS > 2 was similar in total (OR = 0.75 [0.50-1.13], P = 0.17), ruptured (OR = 0.77 [0.49-1.20], P = 0.25), and unruptured cohorts (OR = 0.64 [0.21-1.96], P = 0.44). The OR of obliteration was higher with surgery in the total (OR = 2.52 [1.49-4.27], P = 0.0008) and ruptured cohorts (OR = 2.61 [1.33-5.10], P = 0.005) and unruptured group (OR = 3.46 [1.30-9.20], P = 0.01). The OR of retreatment was lower with surgery in the total (OR = 0.37 [0.17-0.76], P = 0.007) and ruptured cohorts (OR = 0.31 [0.11-0.89], P = 0.03), thought it was similar in the unruptured group (OR = 0.51 [0.08-3.03], P = 0.46). The OR of recurrence was lower with surgery in the total (OR = 0.22 [0.10, 0.47], P = 0.0001), ruptured (OR = 0.16 [0.03, 0.90], P = 0.04), and mixed (un) ruptured cohorts (OR = 0.22 [0.09-0.53], P = 0.0009). The OR of rebleeding in ruptured group was similar (OR = 0.66 [0.29-1.52], P = 0.33). The ORs of other outcomes were similar.
ACoA aneurysms may be safely treated with either surgery or endovascular treatment, although microsurgical clipping demonstrates higher obliteration rates and lower rates of retreatment and recurrence.