Efficacy of surgical clipping and endovascular treatment for middle cerebral artery aneurysms: a retrospective cohort study based on propensity score matching

Abstract

Objective To compare and analyze 2 therapeutic methods, the surgical clipping and endovascular treatment in the clinical efficacy, prognosis, neurological function outcomes, surgical complications and recurrence rate for middle cerebral artery aneurysm. Methods A retrospective cohort study was conducted on 265 patients receiving treatment for middle cerebral artery aneurysms in our hospital from January 2013 to December 2021. These patients were divided into surgical clipping group and endovascular treatment group according to the therapeutic methods they chose. Univariate analysis was used to analyze the recurrence rate in these 2 groups. Clinical prognosis, neurological function outcomes and surgical complication rates of these 2 groups were analyzed based on propensity score matching. Results A total of 162 patients underwent surgical clipping and 103 patients received endovascular treatment. Propensity score matching(PSM) was used to control the baseline characteristics, and 103 patients who received surgical clipping were matched with 103 patients who received endovascular treatment. The good clinical prognosis rate (99.03% vs 86.41%, P < 0.001) and neurological function recovery rate (88.35% vs 63.11%, P < 0.001) of endovascular treatment were higher than those in the surgical clipping group, which were statistically significant. The clipping group had a greater rate of surgical complications than that in the interventional group, with intracranial infection (24.27% vs 5.83%, P < 0.001) being the most significant. No differences were observed in vasospasm, delayed cerebral infarction, hydrocephalus, intraoperative rupture or epilepsy. The endovascular group had a higher recurrence rate than that in the surgical clipping group (3.33% vs 1.11%, P=0.560). Conclusion Endovascular treatment has better clinical prognosis and neurological function outcomes and has fewer surgical complication rates than that of surgical clipping, but surgical clipping appears to result in lower recurrence rates. Endovascular treatment is recommended when both two therapeutic methods are available.

Keywords

• middle cerebral artery aneurysm
• endovascular treatment
• surgical clipping
• propensity score matching