Clipping Versus Coiling in Ruptured Basilar Apex Aneurysms: A Meta-Analysis

Area of Science:

• Neurosurgery
• Endovascular Therapy
• Cerebrovascular Surgery

Background:

• Ruptured basilar apex aneurysms present significant management challenges.
• Both endovascular coiling and surgical clipping are treatment options.

Purpose of the Study:

• To compare the outcomes, effectiveness, and safety of coiling versus clipping for ruptured basilar apex aneurysms.
• To assess reintervention rates and other complications between the two treatment modalities.

Main Methods:

• A systematic review of full-text articles published between 1960 and March 2020 comparing coiling and clipping.
• Data extracted included patient numbers, mortality, neurological deficits, and reintervention rates.
• Outcomes were evaluated at least 6 months post-intervention.

Main Results:

• Nine eligible articles with 582 patients (241 clipping, 341 coiling) were analyzed.
• No significant differences were found in early postoperative mortality, permanent neurological deficit, or late mortality.
• Reintervention rates were significantly higher in the coiling group (OR 2.33, p=0.001).

Conclusions:

• Endovascular coiling is associated with a higher frequency of reinterventions for basilar apex aneurysms.
• Surgical clipping may offer better long-term stability regarding recurrence and reintervention needs.