Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy.

BACKGROUND

Surgical clipping and endovascular coiling are both effective in preventing aneurysmal subarachnoid hemorrhage, but the choice between these interventions remains controversial, leading to treatment disparities across medical centers.

METHODS

A systematic review and meta-analysis were conducted, including relevant two-arm clinical trials up to September 2023, sourced from Scopus, PubMed, Web of Science, and the Cochrane Library. Our primary outcomes were complete occlusion rates during mid-term and long-term follow-ups. Standard mean differences and risk ratios were used to analyze variations in outcomes. Python meta-analysis with sensitivity testing and regional subgroup analysis was used to resolve heterogeneity.

RESULTS

The analysis included 139,485 participants. Clipping demonstrated significantly higher complete occlusion rates in midterm follow-up (RR = 0.83, 95% CI [0.75, 0.91], p = 0.0001) but was associated with a higher risk of procedural complications such as bleeding and ischemic stroke. Coiling showed a higher risk of retreatment (RR = 3.46, 95% CI [1.21, 9.86], p = 0.02), yet it had lower procedural complications (RR = 0.54, 95% CI [0.38, 0.78], p < 0.0009), shorter hospital stays (MD 4.36, 95% CI [2.96, 5.77], p = 0.0001), and better post-procedural outcomes as indicated by lower modified Rankin Scale scores (RR = 0.73, 95% CI [0.55, 0.97], p = 0.03). Long-term occlusion rates were comparable between the two methods.

CONCLUSION

While clipping achieves higher mid-term occlusion rates, coiling is associated with fewer complication rates, shorter hospital stays, and potentially better long-term outcomes. Treatment decisions should be individualized, considering patient-specific characteristics and procedural feasibility.