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Meta-Analysis
. 2022 Apr;45(2):1291-1302.
doi: 10.1007/s10143-021-01704-0. Epub 2021 Dec 6.

Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

Wenjun Zhu  1   2 , Xiaoxiao Ling  3 , Jindong Ding Petersen  4   5 , Jinyu Liu  1   2 , Anqi Xiao  1   2 , Jiayan Huang  6   7
Affiliations
Meta-Analysis

Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

Wenjun Zhu et al. Neurosurg Rev. 2022 Apr.

Abstract

Neurosurgical clipping and endovascular coiling are both standard therapies to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). However, controversy still exists about which is the optimal treatment. This meta-analysis aims to assess the effectiveness and safety of two treatments with high-quality evidence. Web of Science, Cochrane Library, EMBASE, Pubmed, Sinomed, China National Knowledge Infrastructure, and Wanfang Data databases were systematically searched on August 5, 2021. Randomized controlled trials (RCTs) and prospective cohort studies that evaluated the effectiveness and safety of clipping versus coiling in aSAH patients at discharge or within 1-year follow-up period were eligible. No restriction was set on the publication date. Meta-analyses were conducted to calculate the pooled estimates and 95% confidence intervals (CI) of relative risk (RR). Eight RCTs and 20 prospective cohort studies were identified. Compared to coiling, clipping was associated with a lower rebleeding rate at discharge (RR: 0.52, 95% CI: 0.29--0.94) and a higher aneurysmal occlusion rate (RR: 1.33, 95% CI: 1.19-1.48) at 1-year follow-up. In contrast, coiling reduced the vasospasm rate at discharge (RR: 1.45, 95% CI: 1.23-1.71) and 1-year poor outcome rate (RR: 1.27, 95% CI: 1.16-1.39). Subgroup analyses presented that among patients with a poor neurological condition at admission, no statistically significant outcome difference existed between the two treatments. The overall prognosis was better among patients who received coiling, but this advantage was not significant among patients with a poor neurological condition at admission. Therefore, the selection of treatment modality for aSAH patients should be considered comprehensively.

Keywords: Aneurysmal subarachnoid hemorrhage; Effectiveness; Endovascular coiling; Meta-analysis; Neurosurgical clipping; Safety.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the selection procedure. SAH subarachnoid hemorrhage
Fig. 2
Fig. 2
The detailed methodological quality of included RCTs. ISAT the International Subarachnoid Aneurysm Trial
Fig. 3
Fig. 3
Effect of clipping versus coiling on the poor outcome rate at 1-year follow-up. ISAT the International Subarachnoid Aneurysm Trial, CI confidence interval, M-H Mantel–Haenszel method
Fig. 4
Fig. 4
Publication bias of included studies on the vasospasm rate at discharge. SE standard error, RR relative risk
See this image and copyright information in PMC

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