Endovascular Coiling Versus Neurosurgical Clipping for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Abstract

Background Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping. Methods Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software. Results Mortality was found to be significantly higher in the endovascular coiling group (odds ratio (OR): 1.17; confidence interval (CI): 95%, 1.04, 1.32). Re-bleeding was significantly higher in endovascular coiling (OR: 2.87; CI: 95%, 1.67, 4.93). Post-procedure complications were significantly higher in neurosurgical clipping compared to endovascular coiling (OR: 0.36; CI: 95%, 0.24, 0.56). Neurosurgical clipping was a 3.82 times better surgical technique in terms of re-bleeding (Z = 3.82, p = 0.0001). Neurosurgical clipping is a better technique requiring fewer re-treatments compared to endovascular coiling (OR: 4.64; CI: 95%, 2.31, 9.29). Endovascular coiling was found to be a better technique as it requires less rehabilitation compared to neurosurgical clipping (OR: 0.75; CI: 95%, 0.64,0.87). Conclusion Neurosurgical clipping provides better results in terms of mortality, re-bleeding, and re-treatments. Endovascular coiling is a better surgical technique in terms of post-operative complications, favorable outcomes, and rehabilitation.

Endovascular coiling versus neurosurgical clipping for treatment of ruptured and unruptured intracranial aneurysms during pregnancy and postpartum period

“…Regarding the emergent treatment of ruptured IA, the International Subarachnoid Aneurysmal Trial showed that patients undergoing EC have better functional outcomes, assessed using the Glasgow Coma Scale and modified Rankin Scale scores,11 a finding that was confirmed in other studies 12 13. In addition, patients undergoing EC have been shown to have similar 30-day mortality rates but possibly higher rates of recurrence and rebleeding 11 14. Rates of in-hospital mortality and average length of stay in this study were in line with prior data from non-pregnant adults 15 16…”

“…Management of unruptured IA during pregnancy is complicated by the hemodynamic and hormonal changes that may be associated with an increased risk of aneurysm growth and rupture,2 3 14 17 18 as well as the potential maternal and fetal complications from a surgical intervention. When to intervene for unruptured IA during pregnancy remains unknown; however, one may consider deferring treatment until the postpartum period unless there is a compelling indication for urgent intervention 18.…”

Endovascular management of large and giant intracranial aneurysms: Experience from a tertiary care neurosurgery institute in India

“…Another study found that although microsurgical clipping provides better results in terms of re-bleeding, and re-treatments, endovascular approaches are in terms of post-operative complications and favorable outcomes. 1) Coiling, however cannot abate the mass effect due to compression of some large aneurysms. 7) In our study cohort, we performed SAC successfully with under packing of these aneurysms and the third nerve palsy due to this mass effect improved until near complete improvement after three months from the endovascular treatment.…”

Endovascular coiling versus surgical clipping for aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials

“…who included 22 randomized and observational studies and showed that clipping was associated with favorable outcomes in these outcomes. [24] This study included more randomized trials than the analysis by Lindgren et al . and was planned to exclude observational studies to avoid their potential confounders.…”