动脉瘤性蛛网膜下腔出血血管内弹簧圈栓塞与显微外科夹闭的疗效和安全性：随机试验的系统评价与荟萃分析。
完整摘要 · 中文译文
背景：尽管动脉瘤修复技术不断进步，动脉瘤性蛛网膜下腔出血（aSAH）仍具有较高的致残率和死亡率。显微手术夹闭和血管内弹簧圈栓塞是公认的治疗方式，但二者在功能结局和动脉瘤长期闭塞方面的相对优势仍存在争议。本研究按动脉瘤位置和临床分级分层评估治疗效果。 方法：我们筛选了比较夹闭与弹簧圈栓塞治疗破裂颅内动脉瘤的随机对照试验（RCT）。主要结局为1年时良好功能结局[改良Rankin量表（mRS）]及1年时动脉瘤完全闭塞。次要结局包括按部位分层分析、按WFNS分级分层分析及全因死亡率。 结果：共纳入6项RCT，涉及多达3044例患者。采用mRS 0–2标准时，弹簧圈栓塞与1年时良好结局的较高几率相关（OR 1.60，95% CI 1.36–1.88；p < 0.00001），但采用mRS 0–3标准时则无显著差异（OR 1.19，p = 0.12）。按部位分层分析显示，颈内动脉动脉瘤在弹簧圈栓塞后结局更优（OR 0.44，p < 0.00001），而前交通动脉、大脑前动脉、大脑中动脉或后循环动脉瘤无差异。12个月时完全闭塞总体有利于夹闭（OR 0.35，95% CI 0.28–0.44；p < 0.00001；I² = 0%），主要由大脑中动脉动脉瘤中的优势驱动（OR 5.21，p = 0.007）。死亡率无差异（OR 0.89，p = 0.35）。 结论：采用mRS 0–2标准评估时，弹簧圈栓塞可提供更优的1年功能结局，而夹闭可获得更高的完全闭塞率。 闭塞率，主要在大脑中动脉动脉瘤中。未发现死亡率差异。
完整摘要 · 英文原文
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality despite advances in aneurysm repair. Microsurgical clipping and endovascular coiling are established treatment modalities, yet their relative benefits regarding functional outcome and long-term aneurysm occlusion remain debated. This study evaluates treatment effects stratified by aneurysm location and clinical grade. METHODS: We identified RCTs comparing clipping and coiling for ruptured intracranial aneurysms. Primary outcomes were favorable functional outcome at 1-year [modified Rankin Scale (mRS), and complete aneurysm occlusion at 1-year]. Secondary outcomes included location-specific analyses, WFNS grade-specific analyses, and all-cause mortality. RESULTS: Six RCTs involving up to 3044 patients were included. Coiling was associated with higher odds of favorable outcome at 1 year using mRS 0-2 (OR 1.60, 95% CI 1.36-1.88; p < 0.00001), but not when using mRS 0-3 (OR 1.19, p = 0.12). Location-specific analyses showed better outcomes after coiling for internal carotid artery aneurysms (OR 0.44, p < 0.00001), no difference for anterior communicating, anterior cerebral, middle cerebral, or posterior circulation aneurysms. Complete occlusion at 12 months favored clipping overall (OR 0.35, 95% CI 0.28-0.44; p < 0.00001; I2 = 0%), driven by superiority in middle cerebral artery aneurysms (OR 5.21, p = 0.007). Mortality did not differ (OR 0.89, p = 0.35). CONCLUSIONS: Coiling offers superior 1-year functional outcomes when assessed with mRS 0-2, while clipping achieves higher complete occlusion rates, predominantly in middle cerebral artery aneurysms. No mortality difference was found.