Retrospective Analysis Of The Prognosis Of Patients With Ruptured Anterior Communicating Artery Aneurysm Treated With Craniotomy Clipping And Interventional Embolization

Objective: The aim of this study was to investigate the prognosis of microsurgical clipping and interventional embolization of ruptured anterior communicating artery aneurysms under different clinical grades,ages,and treatment timing through retrospective analysis of clinical cases,providing a clinical basis for selecting the best surgical treatment.Methods:1.Data soueces: A total of 82 patients with ruptured anterior communicating artery aneurysm admitted to the East Campus of the Second Hospital of Hebei Medical University from August 2018 to September 2020 were retrospectively analyzed;all cases were treated with spontaneous arachnoid hemorrhage(SAH),intracerebral hematoma or ventricular hemorrhage caused by ruptured anterior communicating artery aneurysm confirmed by CTA and/or DSA..The surgical plan was based on the patient’s own condition and decided after consultation with the patient’s family.2.Collection content: Collect the age,gender,combined diseases(hypertension,diabetes and coronary heart disease),operation time,operation method,Hunt-Hess grade at admission,modified Ranking(m RS)score at discharge,GOS(Glasgow Outcome Scale,GOS)score at 3 months after operation and DSA reexamination results at 3 months after operation,and register one by one to establish a database.3.Study content: Compare the overall disability rate and mortality of the two treatment methods;compare the prognosis of patients with different Hunt-Hess grades under the two treatment methods;compare the relationship between age and prognosis under the two treatment methods;compare the relationship between the operation time and prognosis under the two treatment methods;compare the relationship between aneurysm recurrence 3 months after operation and surgical methods.Results:1.Different Hunt-Hess grades are directly proportional to m Rs prognostic scores: The prognosis of patients with the two treatment methods was negatively correlated with the preoperative Hunt-Hess grade,and the postoperative morbidity and mortality were graded preoperatively.At discharge,the m RS score was 6 points in 3 cases,3-5 points in 19 cases,and0-2 points in 54 cases.The good prognosis rate(m RS0-2 points)was 72.2%and 70.7% in the interventional embolization microsurgical clipping group,respectively,and the poor prognosis(m RS3-6 points)was 27.8% in the interventional embolization group and 29.3% in the microclipping group,P =0.900 > 0.05,without statistical significance.2.Age and prognosis: A total of 76 patients were surgically treated,36 males and 40 females,aged 32 – 76 years,with a mean age of 55.89.The prognosis of patients is negatively correlated with age,and the younger the patient,the better the prognosis.Age < 50 years,Z =-1.300,P = 0.194;age ≥50 years,Z =-0.753,P = 0.451.The disability rate(0/5)and mortality rate(0/5)of interventional embolization therapy in patients younger than 50 years;the disability rate and mortality rate of microclipping group were 14.3% and14.3%,respectively.However,the disability rate(30.7%)and mortality rate(7.7%)of interventional embolization in patients older than 50 years were higher than those in the microsurgical clipping group(disability rate 29.5%,mortality rate 0/44),and there was no statistical significance between the two treatment methods.3.Timing of treatment and prognosis:1)Treatment timing < 24h: Z =-1.603,P = 0.109 > 0.05;2)Treatment timing > 24h: Z =-1.097,P = 0.273 >0.05.The disability rate(26.5%)and mortality rate(4.1%)in the microclipping group were lower than those in the interventional embolization group(disability rate 30.8%,mortality rate 7.6%)when the treatment time was less than 24 hours,but the difference was not significant.There was no difference in the prognosis of patients between the two treatment methods in terms of the choice of operation time.4.Hunt-Hess grade and postoperative 3-month GOS score: Preoperative Hunt-Hess grade was negatively correlated with 3 months after surgery,and the lower the preoperative grade,the better the prognosis at 3 months.The GOS score at 3 months after operation was 5 points in 45 cases,4 points in 13 cases,3 points in 4 cases,2 points in 8 cases,and 1 point in 3 cases.The good prognosis(GOS4-5 score)rates were 78.6% and 82.4% in the microsurgical clipping group and interventional embolization group,respectively,P = 0.517> 0.05,and there was no significant difference in the 3-month prognosis of patients between the two treatment modalities.5.Postoperative aneurysm recurrence: 15 cases were reexamined at 3months after operation,including 9 cases in clipping group,2 cases in aneurysm recurrence group,6 cases in intervention group,1 case in aneurysm recurrence group,Z =-0.255,P = 0.799 > 0.05,without statistical significance.Conclusion: The age and Hunt-Hess grade of the patients were negatively correlated with the clinical prognosis at discharge.Hunt-Hess grade was negatively correlated with GOS score,and the lower the grade,the better the prognosis.When both microsurgical clipping and interventional embolization are appropriate,interventional embolization should be selected as far as possible because the prognosis may be better 3 months after interventional embolization.There is no direct correlation between the timing of surgery and the prognosis of patients.