Efficacy and safety of endovascular coiling compared to microsurgical clipping in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of randomized trials.
Martin Vychopen, Karl-Titus Hoffmann, Erdem Güresir et al.
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In 30 seconds
This systematic review and meta-analysis of six randomised trials, including up to 3044 patients with ruptured intracranial aneurysms, compared endovascular coiling with microsurgical clipping. At one year, coiling was associated with higher odds of a favorable functional outcome defined as mRS 0–2 (OR 1.60, 95% CI 1.36-1.88; p < 0.00001), but not when favorable outcome was defined as mRS 0–3. Clipping achieved higher complete aneurysm occlusion rates overall, particularly for middle cerebral artery aneurysms. All-cause mortality did not differ significantly between treatments.
Key findings
- Coiling was associated with higher odds of 1-year mRS 0–2 outcome (OR 1.60, 95% CI 1.36-1.88; p < 0.00001), but not mRS 0–3 (OR 1.19, p = 0.12).
- Complete occlusion at 12 months favored clipping overall (OR 0.35, 95% CI 0.28-0.44; p < 0.00001), with a reported advantage in middle cerebral artery aneurysms (OR 5.21, p = 0.007).
- Mortality did not differ significantly between coiling and clipping (OR 0.89, p = 0.35).
- Location-specific analyses found better outcomes after coiling for internal carotid artery aneurysms (OR 0.44, p < 0.00001), with no difference reported for other listed locations.
Why it matters
The findings highlight that treatment comparisons depend on the outcome measured: coiling was associated with better function under one mRS threshold, whereas clipping more often achieved complete occlusion. The reported variation by aneurysm location may inform discussion of treatment trade-offs, while the absence of a mortality difference and the differing functional-outcome definitions warrant careful interpretation.
What to keep in mind
The functional advantage for coiling was not significant using the mRS 0–3 definition, and location-specific findings varied. The abstract does not provide detailed information on trial-level differences or follow-up beyond the reported one-year outcomes.