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Published on: August 11, 2015
Neurosurgical Clipping versus Endovascular Coiling for Patients with Intracranial Aneurysms: A Systematic Review and
Zhiqun Jiang1, Yan Chen1, Chunhui Zeng1
1Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Insights
Neurosurgical clipping may be better for ruptured intracranial aneurysms (IAs), but endovascular coiling is safer for unruptured IAs. Clipping reduced mortality and rebleeding for ruptured IAs but increased poor outcomes for unruptured ones.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Cerebrovascular Diseases
Background:
- Intracranial aneurysms (IAs) pose significant risks, necessitating effective treatment strategies.
- Neurosurgical clipping and endovascular coiling are primary interventions for IA management.
- Comparative effectiveness and safety data are crucial for guiding clinical decisions.
Purpose of the Study:
- To compare the efficacy and safety of neurosurgical clipping versus endovascular coiling for intracranial aneurysms (IAs).
- To stratify outcomes based on aneurysm rupture status (ruptured vs. unruptured) and various study parameters.
Main Methods:
- A systematic review and meta-analysis of 64 studies (RCTs, prospective, and retrospective cohorts) comparing clipping and coiling for IAs.
- Data were extracted from PubMed, EmBase, and Cochrane Library up to September 2019.
- Stratified analyses were performed based on study design, patient demographics, aneurysm location, and follow-up duration.
Main Results:
- No significant difference in poor outcomes for ruptured IAs; however, clipping increased poor outcomes for unruptured IAs.
- Clipping showed lower mortality and rebleeding risks for ruptured IAs but higher bleeding risk for unruptured IAs.
- Clipping improved occlusion rates and reduced hydrocephalus risk for ruptured IAs, with no significant differences in infarct or vasospasm.
Conclusions:
- Neurosurgical clipping may offer superior outcomes for ruptured intracranial aneurysms.
- Endovascular coiling appears safer for unruptured intracranial aneurysms due to a lower incidence of poor outcomes and bleeding.
Objective:
We compared the efficacy and safety of neurosurgical clipping with those of endovascular coiling for patients with intracranial aneurysm (IA) stratified by country, publication year, study design, sample size, mean age, percentage of male patients, percentage of aneurysms located in the anterior circulation, and follow-up duration.
Methods:
We identified 64 studies (7 randomized controlled trials, 21 prospective cohort studies, and 36 retrospective studies) of clipping versus coiling for IA from PubMed, EmBase, and the Cochrane Library up to September 2019.
Results:
No significant differences were found in the incidence of poor outcomes observed between clipping and coiling for patients with ruptured IAs. In contrast, the incidence of a poor outcome was significantly increased for unruptured IAs treated by clipping. Clipping was associated with a lower risk of mortality for ruptured IAs, although no significant differences were found between clipping and coiling for unruptured IAs. Clipping was associated with a lower risk of rebleeding for ruptured IAs and an increased risk of bleeding for unruptured IAs. When only randomized controlled trials were included in the analysis, patients with ruptured IAs treated by clipping had an increased incidence of poor outcomes compared with those treated by coiling. Clipping reduced the risk of hydrocephalus and incomplete occlusion and increased the rate of complete occlusion for ruptured IAs. No significant differences in the risk of ischemic infarct and vasospasm were found between clipping and coiling.
Conclusions:
Surgical clipping might be superior to endovascular coiling for ruptured IAs. However, clipping was associated with a greater incidence of poor outcomes and bleeding compared with coiling for unruptured IAs.
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