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Meta-Analysis
. 2020 Mar;99(13):e19654.
doi: 10.1097/MD.0000000000019654.

Endovascular coiling versus surgical clipping for the treatment of unruptured cerebral aneurysms: Direct comparison of procedure-related complications

Xiao-Kui Kang  1 , Sheng-Fu Guo  1 , Yi Lei  2 , Wei Wei  3 , Hui-Xin Liu  4 , Li-Li Huang  5 , Qun-Long Jiang  1
Affiliations
Meta-Analysis

Endovascular coiling versus surgical clipping for the treatment of unruptured cerebral aneurysms: Direct comparison of procedure-related complications

Xiao-Kui Kang et al. Medicine (Baltimore). 2020 Mar.

Abstract

Background: Endovascular coiling and surgical clipping are routinely used to treat unruptured cerebral aneurysms (UCAs). However, the evidence to support the efficacy of these approaches is limited. We aimed to analyze the efficacy of endovascular coiling compared with surgical clipping in patients with UCAs.

Method: A systematic search of 4 databases was conducted to identify comparative articles involving endovascular coiling and surgical clipping in patients with UCAs. We conducted a meta-analysis using the random-effects model when I> 50%. Otherwise, a meta-analysis using the fixed-effects model was performed.

Results: Our results showed that endovascular coiling was associated with a shorter length of stay (WMD: -4.14, 95% CI: (-5.75, -2.531), P < .001) and a lower incidence of short-term complications compared with surgical clipping (OR: 0.518; 95% CI (0.433, 0.621); P < .001), which seems to be a result of ischemia complications (OR: 0.423; 95% CI (0.317, 0.564); P < .001). However, surgical clipping showed a higher rate of complete occlusion after surgery, in both short-term (OR: 0.179, 95% CI (0.064, 0.499), P = .001) and 1-year follow-ups (OR: 0.307, 95% CI (0.146, 0.646), P = .002), and a lower rate of short-term retreatment (OR: 0.307, 95% CI (0.146, 0.646), P = .002). Meanwhile, there was no significant difference in postoperative death, bleeding, and modified Rankin Scale (mRS) > 2 between the 2 groups.

Conclusions: The latest evidence illustrates that surgical clipping resulted in lower retreatment rates and was associated with a higher incidence of complete occlusion, while endovascular coiling was associated with shorter LOS and a lower rate of complications, especially ischemia.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of the study selection process.
Figure 2
Figure 2
Forest plot of odds ratio (OR) of death within 30 days with endovascular coiling versus surgical clipping.
Figure 3
Figure 3
Forest plot of rate difference (RD) of periprocedural bleeding at short-term follow with endovascular coiling versus surgical clipping.
Figure 4
Figure 4
Forest plot of odds ratio (OR) of postoperative complication at short-term follow with endovascular coiling versus surgical clipping.
Figure 5
Figure 5
Forest plot of odds ratio (OR) of postoperative ischemia at short-term follow with endovascular coiling versus surgical clipping.
Figure 6
Figure 6
Forest plot of odds ratio (OR) of postoperative completed occlusion at short-term follow with endovascular coiling versus surgical clipping.
Figure 7
Figure 7
Forest plot of odds ratio (OR) of postoperative completed occlusion at 1-year follow with endovascular coiling versus surgical clipping.
Figure 8
Figure 8
Forest plot of weighted mean difference (WMD) of the length of stay with endovascular coiling versus surgical clipping.
Figure 9
Figure 9
Forest plot of odds ratio (OR) of postoperative retreatment at short-term follow with endovascular coiling versus surgical clipping.
See this image and copyright information in PMC

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