Clinical Comparative Study of Microsurgery and Endovascular Embolization for High-grade Aneurysms
This prospective study aims to compare microsurgical and endovascular embolization for the treatment of
ruptured high-grade intracranial aneurysms in recent years. We compared 281 cases of endovascular
embolization of aneurysms after subarachnoid hemorrhage from 2010 to 2017, and 361 cases of microsurgery.
Neuroradiology and vascular neurosurgery experts decided to use the allocation method. Data acquisition
databases were established in both groups to detect significant differences over a one-year follow-up period. In
this way, we evaluated the changes in treatment over time and compared endovascular embolization with
microsurgery. Compared with the early stage, due to the neck configuration, microsurgical treatment is seldom
selected in the more recent treatment. Over time, endovascular therapy was more frequently chosen (31.9%,
48.8%). Compared with the intravascular treatment group, the incidence of initial symptomatic ischemic stroke
in the microsurgery group decreased significantly and remained stable over time. During the one-year follow-up
period, the number of interventions caused by aneurysms in the endovascular treatment group decreased
significantly, but the rate of occlusion and re-intervention in the microsurgery group increased significantly. The
rate of rebleeding in the intravascular group decreased from 6.1% to 2.2% after 1 year follow-up, which was not
significantly different from that in the microsurgery group (intravascular 2.2%, microsurgery 0.0%, P=0.11).
Microsurgery still has some advantages in the treatment of high-grade aneurysms, but endovascular
embolization is also improving rapidly.