Comparison of microsurgical clipping with intravascular interventional embolization in the treatment of ruptured aneurysms and risk factors for intraoperative rupture and bleeding

OBJECTIVE

To investigate the effectiveness of microsurgical clipping compared with intravascular interventional embolization in the treatment of ruptured aneurysms and the risk factors for intraoperative rupture and bleeding.

METHODS

The data of 116 patients with ruptured aneurysms admitted to the People's Hospital of China Three Gorges University from January 2020 to March 2021 were collected for retrospective analysis. Among them, 61 cases with microsurgical clipping were classified as the control group (CG), and the rest 55 with intravascular interventional embolization were the observation group (OG), and the treatment effects in the two groups were compared. The general conditions of operation (operation time, postoperative hospital stay and intraoperative blood loss) were compared between the two groups. The intraoperative rupture of cerebral aneurysm during operation was counted, and the incidence of complications between the groups was compared. Risk factors affecting intraoperative rupture of cerebral aneurysms were analyzed by logistic regression.

RESULTS

The total clinical treatment efficiency was dramatically higher in the OG than that in the CG (P<0.05). The operative time, postoperative hospital stays, and intraoperative bleeding were all higher in the CG than those in the OG (all P<0.001). There was no statistical difference in the incidence of wound infection, hydrocephalus, and cerebral infarction between the two groups (all P>0.05). However, the incidence of intraoperative rupture was markedly higher in the CG than that in the OG (P<0.05). Multifactorial logistic regression analysis revealed that history of subarachnoid hemorrhage, history of hypertension, large diameter of aneurysm, irregular morphology, and anterior communicating artery aneurysm were independent risk factors for intraoperative rupture in patients.

CONCLUSION

Intravascular interventional embolization for middle cerebral artery aneurysm rupture is a less invasive procedure with faster recovery time, and history of subarachnoid hemorrhage, history of hypertension, large diameter of aneurysm, irregular morphology, and anterior communicating artery aneurysm are independent risk factors affecting patients with intraoperative rupture.

The effect of intravascular interventional embolization and craniotomy on MMP-2, MMP-9 and caspase3 in serum of intracranial aneurysm patients

The effect of intravascular interventional embolization and surgical operation on matrix metalloprotein (MMP)-2, MMP-9 and caspase3 in serum of intracranial aneurysms was analyzed to study the mechanisms. Seventy-nine patients of intracranial aneurysms from September 2011 to August 2014 were divided into the intervention group (n=41) and the craniotomy group (n=38) based on treatment methods, and 40 cases of normal volunteers with normal physical examination were selected as the control group. Patients in the intervention group were treated with intravascular interventional embolization, and the surgical group was treated with craniotomy and no treatment was performed in the control group. The survival rate and adverse reaction rate were calculated. ELISA kit was used to detect the level of reactive oxygen species (ROS), interleukin-6 (IL-6), tumor necrosis factor (TNF-α) and IL-10 in serum; the mRNA and protein expression levels of MMP-2, MMP-9 and caspase3 in serum were detected by qPCR and western blotting; the protein expression levels of p-adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK), Bcl-2 and Bax were also detected. The survival rate of patients in the intervention group was significantly higher than that in the craniotomy group (P<0.05). The ROS level in the intervention and craniotomy groups was significantly higher than that in the control group (P<0.01), while the levels of IL-6 and TNF-α in the serum of the intervention group were lower than those in the craniotomy group (P<0.01). The mRNA and protein expression of MMP-2, MMP-9 and caspase3 of the intervention group was significantly lower than that of the craniotomy group (P<0.01). The protein expression of p-AMPK and Bcl-2/Bax in the intervention group were lower than that in the craniotomy group (P<0.01). Intravascular interventional surgery can significantly increase the patient's survival time, and effectively reduce the expression of MMP-2, MMP-9 and caspase3 in the serum of intracranial aneurysm patients. The mechanism may be through the impact of ROS levels, thereby affecting the p-AMPK and Bcl2/Bax expression.