Comparative efficacy and safety of clipping versus coiling for unruptured intracranial aneurysms: A comprehensive meta-analysis
Ali Hammed (Siegen), Christian Tanislav (Siegen), Omar Alomari (Istanbul / TR), Zina Otmani (Tizi-ouzou / DZ), Khalid Sarhan (Mansoura / EG), Abdelrahman M. Hamouda (Rochester, NY / US)
Unruptured intracranial aneurysms (UIAs) are prevalent, with an estimated occurrence rate ranging from 2% to 3%. Surgical or endovascular preventive interventions can effectively eliminate the risk of aneurysmal subarachnoid hemorrhage. However, the debate over whether to opt for surgical clipping or endovascular coiling remains contentious, resulting in notable variations in treatment approaches across different medical centers.
A systematic review was conducted by comprehensively searching through Scopus, PubMed, Web of Science (WOS), and the Cochrane Library for relevant studies up to September 2023. Two independent reviewers meticulously screened and extracted data, with the assessment of study quality carried out using the Robin 1+2 tool. Standard mean differences, odds ratios, and risk ratios were employed to identify variations in the dataset.
31 studies have been included in our analysis encompassing 155,728 patients. In our analysis, complete occlusion demonstrated a significantly superior outcome within the coiling group (odds ratio 0.29, p-value 0.002), even that the coiling group exhibited a higher risk of mortality (odds ratio 0.83, p-value 0.03). The need for retreatment after clipping was significantly elevated, with the risk of retreatment being 3.46 times higher in the clipping group (p-value 0.02). Post-surgery bleeding exhibited a higher prevalence in the coiling group (odds ratio 0.57, p-value 0.006), whereas there was no statistically significant difference in infarction occurrence following intervention between the two groups. Quality of life and disability did not show significant differences between the two intervention methods. Lastly, coiling showed a higher prevalence of Modified Rankin Scale (mRS) scores surpassing 2 compared to clipping.
In the absence of established criteria guiding the selection between clipping and coiling, our findings suggest that coiling exhibits superior complete occlusion, and the requirement for retreatment is less frequent compared to clipping. However, it is important to note that coiling is associated with a higher risk of bleeding and death. While coiling demonstrates favorable intervention outcomes, the presence of complications underscores the importance of individualized decision-making, considering patient-specific factors, for optimal treatment selection.
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