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. 2019 Mar 26;11(3):e4320.
doi: 10.7759/cureus.4320.

Endovascular Coiling Versus Neurosurgical Clipping for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Syed Ijlal Ahmed  1 , Gohar Javed  2 , Syeda Beenish Bareeqa  3 , Syeda Sana Samar  4 , Ali Shah  5 , Arwa Giani  6 , Zainab Aziz  7 , Abeer Tasleem  7 , Syed Hasham Humayun  8
Affiliations

Endovascular Coiling Versus Neurosurgical Clipping for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Syed Ijlal Ahmed et al. Cureus. .

Abstract

Background Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping. Methods Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software. Results Mortality was found to be significantly higher in the endovascular coiling group (odds ratio (OR): 1.17; confidence interval (CI): 95%, 1.04, 1.32). Re-bleeding was significantly higher in endovascular coiling (OR: 2.87; CI: 95%, 1.67, 4.93). Post-procedure complications were significantly higher in neurosurgical clipping compared to endovascular coiling (OR: 0.36; CI: 95%, 0.24, 0.56). Neurosurgical clipping was a 3.82 times better surgical technique in terms of re-bleeding (Z = 3.82, p = 0.0001). Neurosurgical clipping is a better technique requiring fewer re-treatments compared to endovascular coiling (OR: 4.64; CI: 95%, 2.31, 9.29). Endovascular coiling was found to be a better technique as it requires less rehabilitation compared to neurosurgical clipping (OR: 0.75; CI: 95%, 0.64,0.87). Conclusion Neurosurgical clipping provides better results in terms of mortality, re-bleeding, and re-treatments. Endovascular coiling is a better surgical technique in terms of post-operative complications, favorable outcomes, and rehabilitation.

Keywords: aneurysm clip; coiling; endovascular; neurosurgery; sub arachnoid hemorrhage.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The flow diagram for data extraction strategy in accordance with PRISMA guidelines
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis
Figure 2
Figure 2. The detailed meta-analysis on endovascular coiling versus neurosurgical clipping
Figure 3
Figure 3. Figure shows funnel plot
See this image and copyright information in PMC

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