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Meta-Analysis
. 2012 Sep 22:12:99.
doi: 10.1186/1471-2377-12-99.

Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review

Jin Seub Hwang  1 , Min Kyung Hyun, Hyun Joo Lee, Ji Eun Choi, Jong Hee Kim, Na Rae Lee, Jin-Won Kwon, EnJu Lee
Affiliations
Meta-Analysis

Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review

Jin Seub Hwang et al. BMC Neurol. .

Abstract

Background: To compare the effects of endovascular coiling and neurosurgical clipping in patients with unruptured intracranial aneurysm.

Methods: Sixteen electronic databases were searched for articles published between 1950 and July 2010 to compare clinical outcomes of clipping and coiling. Researchers reviewed all searched articles and extracted data independently. The quality of studies and evidence were evaluated using MINORS and GRADEprofiler, respectively. The odds ratio (OR) was calculated using the inverse variance meta-analysis method for each study outcome. To assess heterogeneity of ORs across cohorts, Cochran's Q statistic and I² were used.

Results: Of 4160 studies, 24 were identified (n = 31865). Clipping resulted in significantly higher disability using the Glasgow Outcome Scale (OR, 2.38; 95% CI, 1.33-4.26) and Modified Rankin Scale (OR, 2.83; 95% CI, 1.42-5.63) when compared with coiling. ORs for complications were also higher with clipping (ORs for neurological and cardiac complications were 1.94 with a 95% confidence interval [CI] of 1.09-3.47 and 2.51 with a 95% CI of 1.15-5.50). Clipping resulted in significantly greater disability in the short term (≤6 m)(OR on the Glasgow Outcome Scale, 2.72; 95% CI, 1.16-6.34), but not in the long term (>6 m)(OR for Glasgow Outcome Scale, 2.12; 95% CI, 0.93-4.84).

Conclusions: Coiling was a better procedure for treatment of unruptured intracranial aneurysm in terms of disability, complications, especially in the short term. Because of the limitations of the reviewed studies, further studies are required to support the present results.

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Figures

Figure 1
Figure 1
Flow diagram of article selection for this study
Figure 2
Figure 2
Outcomes from neurosurgical clipping vs. endovascular coiling
Figure 3
Figure 3
Outcomes from neurosurgical clipping vs. endovascular coiling (complications)
See this image and copyright information in PMC

References

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