Turkish Neurosurgery
Comparative analysis of clipping and endovascular therapy outcomes in the treatment of ruptured distal anterior cerebral artery aneurysms
Vikas jha1, Shahnawaz Alam2, Vivek Saran Sinha3
1AIIMS,Patna, Neurosurgery, Patna,
2AIIMS,Patna, Neurosurgery, Patna,
3AIIMS,Patna, Neurosurgery, Patna,
DOI: 10.5137/1019-5149.JTN.37564-22.2

Aim:Past research into the treatment of distal anterior cerebral artery (DACA) aneurysms with endovascular therapy (EVT) has found the procedure to result in inferior outcomes to clipping. However, better results have recently been reported. We compared the outcomes of DACA aneurysm treatment using these two procedures and assessed the risk factors.Material and Methods: We retrospectively sampled and analyzed 31 patients treated for ruptured DACA aneurysms from a larger sample of 250 patients treated for ruptured aneurysms between July 2018 and July 2021. The outcomes of patients who underwent clipping and EVT were compared using chi-square tests. T-tests were used for univariate analysis and a logistic regression analysis was used to determine the risk factors affecting outcomes.Results:Of the 31 patients, 20 were treated with clipping and 11 with EVT. Patients treated with EVT had a mean age of 35.45±6.66. The mean age of the clipping group was 44.4±6.94 years (p=0.002). Intraoperative rupture was significantly more common in the clipping group (p=0.025). There were no significant differences in the postoperative incidence of vasospasm or hydrocephalus (p=0.12). Modified Rankin Scale scores (p=0.017) and Glasgow Outcome Scale scores (p=0.02) both at discharge and 6-month follow-ups were significantly better in the EVT group than in the clipping group. Length of stay in the ICU was 9.27 ± 2.6 days following EVT and 23.60±6.29 following clipping (p=0.001). Age (p=0.0136), Hunt and Hess grade (p=0.02), and the occurrence of intraprocedural rupture (p=0.009) were found to significantly affect outcomes.Conclusion:The outcomes of EVT were better than those for clipping and required a shorter stay in the ICU and the hospital. This may be partially attributable to the dual-trained neurovascular surgeon who performed the procedures. Older age, poorer Hunt and Hess grades, and intraoperative aneurysm rupture adversely affected outcomes.

Corresponding author : Vikas jha