Surgical clipping compared to endovascular coiling of ruptured coil able middle cerebral aneurysms: A single-center experience

Ghorbani, Mohammad; Griessenauer, Christoph J.; Wipplinger, Christoph; Nouri, Mohsen; Asaadi, Sina; Hejazian, Ebrahim; Mollahoseini, Reza; Mortazavi, Abolghasem

doi:10.1016/j.inat.2020.100708

Cited by 3 publications

(6 citation statements)

References 32 publications

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“…After further reading the abstract and full text, we then excluded 213 reviews, guidelines, conferences, case reports, and 25 studies that did not meet the criteria for inclusion of patients or with incomplete data. Ultimately, 10 eligible studies were incorporated into the analysis [7,[9][10][11][12][13][14][15][16][17]. The procedure for sifting through the literature is depicted in Figure 1.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…(1) Complete occlusion rate: 3 studies [12,14,17] with a total of 228 patients reported the complete occlusion rate, and the study data were not statistically heterogeneous (I 2 =0%, Am J Transl Res 2024;16(5):1845-1858 al. [7] was the source of the heterogeneity.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…(3) Postoperative residual or recurrence rate: 8 studies [9,[11][12][13][14][15][16][17], which included a total of 1,860 patients, showed statistical heterogeneity in the data (I 2 =61%, P=0.01), so a randomeffects model was used. Compared to microsurgical clipping, endovascular coiling increased the rate of postoperative residual or recurrence [OR=0.40, 95% CI (0.17, 0.91), P=0.03] (Figure 7).…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…(5) Incidence of postoperative ischemic stroke: 7 studies [7,9,[11][12][13][14]17], which included a total of 1,705 patients, reported incidence of P=0.62), so a fixed-effects model was used. No significant difference was found in the complete occlusion rate when comparing the clip and coil groups [OR=1.76, 95% CI (0.78, 3.96), P=0.17] (Figure 2).…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

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Efficacy of endovascular embolization versus microsurgical clamping in the treatment of intracranial aneurysms: a meta-analysis

Deng

2024

Am J Transl Res

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Intracranial aneurysms (IA) can induce increased intracranial pressure, headache, and the development of nausea and vomiting if not treated in time, and failure to receive timely diagnosis and treatment can lead to disability or death. However, the efficacy and prognostic value of craniotomy and endovascular embolization in patients with IA remains a controversial topic. This meta-analysis systematically evaluated the efficacy of endovascular coiling versus cranial aneurysm clamping on the immediate postoperative outcome and prognosis of patients with IA. PubMed, EMBASE, and the Cochrane Library databases were searched for retrieval of relevant references. Literature was screened according to pre-defined inclusion and exclusion criteria, and data were extracted and assessed for quality. A total of 10 studies, including 2,654 cases, were included in the analysis. Among them, 1,313 cases underwent craniotomy clipping surgery (clip group), and 1,341 cases underwent endovascular coiling (coil group). The quality of the studies in 8 articles evaluated using the Newcastle-Ottawa Scale (NOS) was ≥6. Meta-analysis was conducted using Rev Man 5.3 and Stata 17 software. The results of meta-analysis showed that no significant difference in complete occlusion rate [OR=1.76, 95% CI (0.78, 3.96), P=0.17] when comparing the clip and coil group. Compared to the clip group, the coil group had a better clinical short-term outcome [OR=1.55, 95% CI (1.05, 2.27), P=0.03], but an increased rate of postoperative residual or recurrence [OR=0.40, 95% CI (0.17, 0.91), P=0.03]. In addition, there were no significance differences identified in terms of complications, including the rates of postoperative rebleeding [OR=1.60, 95% CI (0.97, 2.63), P=0.07], ischemic stroke [OR=1.12, 95% CI (0.45, 2.79), P=0.81], and cerebral vasospasm [OR=0.90, 95% CI (0.13, 6.03), P=0.91]. Subsequently, we conducted experimental sequence analysis for each indicator, and the results were consistent with the results of meta-analysis. According to the recent clinical prognosis, a funnel plot was constructed, showing significant asymmetry on both sides, indicating some publication bias. However, the results of Begg's test with P=0.734 and Egger's test with P=0.633 suggest no significant publication bias. In general, endovascular coiling and microsurgical clipping appear to be equally effective in achieving vascular occlusion. Endovascular coiling may be more effective in improving the short-term clinical outcomes for patients. However, this approach may increase the rate of postoperative residual issue or recurrence.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Meta-analysis Resultsmentioning

confidence: 99%

Section: Meta-analysis Resultsmentioning

confidence: 99%

Section: Meta-analysis Resultsmentioning

confidence: 99%

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Efficacy of endovascular embolization versus microsurgical clamping in the treatment of intracranial aneurysms: a meta-analysis

Deng

2024

Am J Transl Res

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“…Excluding reviews or meta-analyses, medical records reports, meeting minutes and animal experiments, a total of 1396 literatures were obtained. Thirty studies [7–36] were obtained by reading abstracts combined with inclusion criteria and exclusion criteria. All the literatures are comparative studies of interventional embolization and surgical clipping in the treatment of ruptured middle cerebral artery aneurysms.…”

Section: Resultsmentioning

confidence: 99%

Microsurgical clipping and endovascular intervention for middle cerebral artery aneurysm: A meta-analysis

Zhang,

Liu,

Xing

et al. 2023

Medicine

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Background: The purpose of this study is to compare the prognosis and effective rate of interventional embolization and surgical clipping in the treatment of middle cerebral artery aneurysms, to provide evidence-based basis for the selection of clinical treatment. Methods: By searching PubMed, Cochrane library, Medline, Embase and other databases, we collected the related studies interventional embolization and surgical clipping in the treatment of middle cerebral artery aneurysms, whether it was a randomized controlled trial or not. According to the relevant inclusion and exclusion criteria, 2 researchers independently screened and extracted the relevant data. Quality of life, residual neck and recurrence rate, incidence of ischemic cerebral infarction, intracranial infection rate, incidence of vasospasm and rebleeding rate were measured. Revman5.4 software was used for Meta-analysis. Results: There were 3658 patients included in 30 literatures, including 1478 patients treated with interventional embolization and 2180 patients treated with surgical clipping. The rate of low quality of life (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.36–2.07, P < .00001) and intracranial infection rate (OR = 8.79,95% CI: 4.47–17.27, P < .00001) in the interventional embolization group were lower than those in the surgical clipping group. The postoperative rebleeding rate (OR = 0.46, 95% CI: 0.29–0.73, P = .0009), residual neck and recurrence rate (OR = 0.32, 95% CI: 0.24–0.43, P < .00001) in the interventional embolization group were higher than those in the surgical clipping group. The heterogeneity of residual neck and recurrence rate were high, so subgroup analysis was performed. We divide them into short-term group (OR = 0.68, 95% CI: 0.40–1.13, P = .13) and long-term group (OR = 0.23, 95% CI: 0.16–0.33, P < .00001). The results showed that the residual neck and recurrence rate in the interventional embolization group were higher than those in the surgical clipping group. There was no significant difference in the incidence of cerebral vasospasm (OR = 1.09, 95% CI: 0.64–1.86, P = .74) and ischemic stroke (OR = 0.87, 95% CI: 0.63–1.19, P = .37) between the 2 treatments. Conclusion: According to the current clinical research evidence, compared with interventional embolization in the treatment of middle cerebral artery aneurysms, the quality of life of patients after clipping is lower, the incidence of intracranial infection is higher, but the residual neck, and recurrence rate are reduced. The risk of rebleeding is also reduced. There was no significant difference in the incidence of vasospasm and ischemic stroke between the 2 groups.

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Neurosurgical clipping versus endovascular coiling for patients with ruptured anterior circulation aneurysms: A systematic review and meta-analysis

Peng,

Qin,

Liu

et al. 2024

Neurosurg Rev

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Surgical clipping compared to endovascular coiling of ruptured coil able middle cerebral aneurysms: A single-center experience

Cited by 3 publications

References 32 publications

Efficacy of endovascular embolization versus microsurgical clamping in the treatment of intracranial aneurysms: a meta-analysis

Efficacy of endovascular embolization versus microsurgical clamping in the treatment of intracranial aneurysms: a meta-analysis

Microsurgical clipping and endovascular intervention for middle cerebral artery aneurysm: A meta-analysis

Neurosurgical clipping versus endovascular coiling for patients with ruptured anterior circulation aneurysms: A systematic review and meta-analysis

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