Long-term outcomes of endovascular simple coiling versus neurosurgical clipping of unruptured intracranial aneurysms: A systematic review and meta-analysis.
J Neurol Sci
; 422: 117338, 2021 Mar 15.
Article
in En
| MEDLINE
| ID: mdl-33596532
ABSTRACT
BACKGROUND:
Previous studies on ruptured intracranial aneurysms have shown favourable long-term outcomes of patients undergoing endovascular coiling compared to neurosurgical clipping. We aimed to evaluate if these results also apply to patients with unruptured intracranial aneurysms (UIAs).METHODS:
Embase, PubMed, and Cochrane Library were systematically searched for all studies reporting long-term (≥3 years) follow-up after coiling or clipping of UIAs. Thirteen studies involving 16,622 coiled patients and 13,606 clipped patients were included. Short-term outcome was defined as death ≤30 days after treatment. Long-term outcomes (>3 years) included all-cause mortality, morbidity (defined as modified Rankin Score 3-5 or Glasgow Outcome Score 2-3), cerebrovascular accident, intracerebral haemorrhage, additional repairs, and lost to follow-up. We calculated relative risk (RR), incidence and mortality rates (IR and MR), together with incidence and mortality rate ratio (IRR and MRR).RESULTS:
Patients treated with simple coiling had lower short-term mortality than clipped patients (RR = 0.62 (95%CI 0.42-0.91)), but this difference disappeared after long-term follow-up ((MRR) = 0.89 (95%CI 0.78-1.02). Coiled patients had higher retreatment rates than clipped patients (IRR = 1.70 (95%CI 1.50-1.93)).CONCLUSIONS:
This systematic review and meta-analysis reports benefits and drawbacks of simple coiling versus neurosurgical clipping of UIAs. Future studies with longer follow-up time should account for differences in coiling techniques and confounding factors such as size and location of UIAs.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Intracranial Aneurysm
/
Aneurysm, Ruptured
/
Embolization, Therapeutic
/
Endovascular Procedures
Type of study:
Etiology_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
J Neurol Sci
Year:
2021
Document type:
Article
Affiliation country:
Denmark
Publication country:
HOLANDA
/
HOLLAND
/
NETHERLANDS
/
NL
/
PAISES BAJOS
/
THE NETHERLANDS