Comparison of feasibility and efficacy of microsurgery and interventional techniques in the management of unruptured middle cerebral artery aneurysms with a history of transient ischemic attack.
Source: PubMed, NCBI / U.S. National Library of Medicine
To compare the feasibility and efficacy of microsurgery and interventional techniques in the treatment of unruptured middle cerebral artery aneurysms (MCAA) with a history of transient ischemic attack (TIA). A prospective cohort comparative study was conducted using 100 patients with unruptured MCAA and a history of TIA who were admitted to our hospital from January 2023 to October 2024. The patients were divided into an interventional group and a microsurgical group, with 50 patients in each group. The interventional group underwent endovascular embolization, while the microsurgical group received microsurgical treatment. Various surgical outcomes were compared between the two groups, including procedure time, blood loss, postoperative hospital stay, and treatment costs. Rates of complete and incomplete aneurysm occlusion, treatment-related serious adverse events within 30 days after surgery, functional outcomes at 6 months after surgery as measured by the modified Rankin Scale (mRS), levels of miR-27a and miR-143, and recurrence rates at 1 year after surgery were also analyzed. Additionally, the cure rates for aneurysms in terms of shape and location were compared between the two groups. In the interventional group, the operation time, blood loss, and postoperative hospital stay were lower than those in the microsurgical group. However, the treatment cost was higher in the interventional group ( < 0.05). The complete occlusion rate in the interventional group
Abstract
To compare the feasibility and efficacy of microsurgery and interventional techniques in the treatment of unruptured middle cerebral artery aneurysms (MCAA) with a history of transient ischemic attack (TIA). A prospective cohort comparative study was conducted using 100 patients with unruptured MCAA and a history of TIA who were admitted to our hospital from January 2023 to October 2024. The patients were divided into an interventional group and a microsurgical group, with 50 patients in each group. The interventional group underwent endovascular embolization, while the microsurgical group received microsurgical treatment. Various surgical outcomes were compared between the two groups, including procedure time, blood loss, postoperative hospital stay, and treatment costs. Rates of complete and incomplete aneurysm occlusion, treatment-related serious adverse events within 30 days after surgery, functional outcomes at 6 months after surgery as measured by the modified Rankin Scale (mRS), levels of miR-27a and miR-143, and recurrence rates at 1 year after surgery were also analyzed. Additionally, the cure rates for aneurysms in terms of shape and location were compared between the two groups. In the interventional group, the operation time, blood loss, and postoperative hospital stay were lower than those in the microsurgical group. However, the treatment cost was higher in the interventional group ( < 0.05). The complete occlusion rate in the interventional group was 88.00%, which was lower than 100.00% in the microsurgical group ( < 0.05). The incidence of treatment-related SAEs within 30 days after surgery was 4.00% in the interventional group, compared to 16.00% in the microsurgical group ( < 0.05). At 6 months postoperatively, the rate of good functional outcomes was 92.00% in the interventional group, similar to 98.00% in the microsurgical group, with no statistically significant difference between the two groups ( > 0.05). Compared to preoperative levels, both groups showed significantly increased miR-27a and miR-143 levels at 3 days postoperatively ( < 0.05). However, the levels of miR-27a and miR-143 were lower in the interventional group at 3 days postoperatively than in the microsurgical group ( < 0.05). The recurrence rate at 1 year was 12.00% in the interventional group, compared to 0% in the microsurgical group ( < 0.05). For aneurysms with complex anatomies (wide neck, apex-neck ratio < 1.5, involvement of branches, or irregular shape), the complete occlusion rate after interventional treatment was significantly lower, and the 1-year recurrence rate was significantly higher ( < 0.05). Both microsurgery and interventional techniques are feasible therapeutic strategies for patients with unruptured MCAA and a history of TIA. Interventional techniques have the advantages of shorter operation time, less blood loss, faster postoperative recovery and higher perioperative safety, whereas microsurgery yields a higher complete occlusion rate and lower recurrence risk.