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Updated: Mar 1, 2026
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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
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Ruptured middle cerebral artery aneurysm treatment with primary coiling versus clipping: A comparative meta-analysis
Wei Jun Lee1, Rafaela Correia Maciel2, Tam Qm Tran3
1Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Clinical Neurology and Neurosurgery
|February 27, 2026
Summary
Microsurgical clipping and endovascular coiling offer similar functional outcomes for ruptured middle cerebral artery aneurysms. However, clipping demonstrates superior complete aneurysm occlusion rates, suggesting a need for further research into advanced coiling techniques.
Area of Science:
- Neurosurgery
- Interventional Neurology
- Vascular Neurology
Background:
- Intracranial aneurysms are increasingly managed with endovascular coiling, shifting from traditional microsurgical clipping.
- The optimal treatment strategy for ruptured middle cerebral artery (MCA) aneurysms remains a subject of debate.
- This study addresses the controversy by comparing coiling and clipping for ruptured MCA aneurysms.
Purpose of the Study:
- To systematically review and meta-analyze the radiological and clinical outcomes of ruptured MCA aneurysms treated with primary coiling versus microsurgical clipping.
- To compare functional outcomes (mRS scores) and aneurysm occlusion rates between the two treatment modalities.
- To provide evidence-based insights into the preferred treatment strategy for ruptured MCA aneurysms.
Main Methods:
- An extensive literature search was conducted across PubMed, Embase, and Cochrane databases up to August 2025.
- Primary outcomes included modified Rankin Scale (mRS) scores at discharge and long-term follow-up.
- Secondary outcomes were aneurysm occlusion rates post-procedurally/at discharge and long-term; pooled risk ratios (RRs) were calculated using a random-effects model.
Main Results:
- The meta-analysis included 5 studies with 984 patients (449 coiling, 535 clipping).
- No significant difference in good functional outcomes (mRS 0-2) was observed between coiling and clipping at discharge (RR: 1.04) and long-term follow-up (RR: 1.07).
- Endovascular coiling was associated with significantly lower rates of complete aneurysm occlusion at discharge (RR: 0.66) and long-term follow-up (RR: 0.76).
Conclusions:
- Microsurgical clipping and primary endovascular coiling yield comparable functional outcomes for ruptured MCA aneurysms.
- Microsurgical clipping is associated with higher rates of complete aneurysm occlusion compared to coiling.
- Further research with larger cohorts, prospective data, and contemporary endovascular techniques is warranted to refine treatment strategies.
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