Endovascular Coiling versus Microsurgical Clipping for Ruptured Intracranial Aneurysms: A Meta-Analysis and Systematic Review.

Abstract

\n Objectives: The purpose of this analysis is to evaluate the current evidence with regard to efficiency and safety between coiling and clipping in patients with ruptured intracranial aneurysms (RIAs).Methods: We performed a meta-analysis that compared clipping with coiling between July 2000 and September 2019. PubMed, EMBASE, and the Cochrane Library were searched for related articles systematically. Results: We identified three randomized controlled trials and thirteen-six observational studies involving 60217 patients with ruptured cerebral aneurysms. The summary results showed that coiling was related a better quality of life (mRS0-2; OR=1.462; CI=1.2375-1.676; P=0.000), a higher risk of mortality (OR=1.116; CI=1.054-1.180; P=0.000), higher rate of rebleeding (RR=1.410; CI=1.092-1.822; P=0.000), lower incidence of vasospasm (OR=0.787; CI=0.649-0.954; P=0.015), lower risk of hydrocephaly (RR=1.143; CI=1.043-1.252; P=0.004), lower risk of cerebral infarction (RR=0.669; CI=0.596-0.751; P=0.000), lower risk of neuro deficits(RR=0.720; CI=0.582-0.892; P=0.003), lower pulmonary complications(RR=0.456; CI=0.232-0.896; P=0.023), and shorter length of stay in hospital and ICU(WMD=-2.290; CI=-3.423--1.157; P=0.000, SMD=-0.346; CI=-0.459--0.234; P=0.000, respectively), a lower rate of complete occlusion(OR=0.495; CI=0.280-0.876; P=0.016). There were no significant difference with regard to the result of GOS (4-5) and the incidence of seizure, intracranial infection.Conclusion: Coiling was significantly associated with a better life quality (mRS0-2), a lower incidence of postoperative complications (vasospasm, hydrocephaly, cerebral infarction, neuro deficits, pulmonary complications), and a higher rate of mortality, rebleeding than clipping. What’s more, coiling was associated with a lower rate of complete occlusion. There was no significant difference about seizure and intracranial infection and the result of GOS (4-5) between the two groups.