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Neurosurgical clipping versus endovascular coiling for patients with ruptured anterior circulation aneurysms: A systematic review and meta-analysis

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Abstract

To compare the safety and efficacy of clipping and coiling in patients with ruptured anterior circulation aneurysms. A systematic search of four databases (PubMed, Web of Science, Cochrane Library, and Embase) was conducted to identify comparative articles on endovascular coiling and surgical clipping in patients with ruptured anterior circulation aneurysms. Meta-analyses were conducted using random-effects models. Nineteen studies, including 1981 patients, were included. The meta-analysis showed that neurosurgical clipping was associated with a lower incidence of retreatment (OR:0.28, 95% CI (0.11, 0.70), P = 0.006) than endovascular coiling, which seemed to be a result of incomplete occlusion (OR:0.22, 95% CI (0.11, 0.45), P < 0.001). Neurosurgical clipping was associated with lower mortality (OR:0.45, 95% CI (0.25, 0.82), P = 0.009) at short-term follow-up than endovascular coiling. However, neurosurgical clipping showed a higher incidence of ischemic infarction (OR:2.28, 95% CI (1.44, 3.63), P < 0.001) and a longer length of stay (LOS) (WMD:6.12, 95% CI (4.19, 8.04), P < 0.001) after surgery than endovascular coiling. Furthermore, the pooled results showed no statistically significant differences between the two groups regarding poor outcome, long-term mortality, rebleeding, vasospasm, and hydrocephalus. Evidence from this systematic review illustrates that neurosurgical clipping may be superior to endovascular coiling for ruptured anterior circulation aneurysms. Large-scale RCTs should be conducted to verify these outcomes and provide results according to patient status.

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Funding

This study was supported by the Scientific Research Initiation Fund for Talent Introduction of Shanxi Bethune Hospital, Shanxi Province, China (2021RC006). The funders had no role in the study design, data collection, and analysis, decision to publish, and manuscript preparation.

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Authors and Affiliations

  1. Department of Neurosurgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China

    Liangsheng Peng, Jiahao Liu & Xinmin Ding

  2. Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China

    Hao Qin, Xiaolong Wang & Li Han

  3. Department of Internal Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China

    Nuojun Wu

  4. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Xinmin Ding

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  1. Liangsheng Peng
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Contributions

X.D. and L.P. conceived and planned the study. H.Q., J.L., and N.W. did the literature retrieve, extracted data, and evaluated study quality. L.P. and H.Q. analyzed and interpreted data. L.P. wrote the initial draft of the manuscript.X.D., X.W., and L.H. critically reviewed and revised the draft. All authors reviewed the manuscript.

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Correspondence to Xinmin Ding.

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The original online version of this article was revised: The authors regret that one sentence in the abstract section of the published original article is incorrect.

The incorrect sentence is: Nineteen studies, including 1983 patients, were included.

The correct sentence is: Nineteen studies, including 1981 patients, were included.

The original article has been corrected.

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Peng, L., Qin, H., Liu, J. et al. Neurosurgical clipping versus endovascular coiling for patients with ruptured anterior circulation aneurysms: A systematic review and meta-analysis. Neurosurg Rev 47, 68 (2024). https://doi.org/10.1007/s10143-024-02304-4

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