Coiling is not superior to clipping in patients with high-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

• Published in: World neurosurgery Vol. 98; pp. 411 - 420
• Main Authors: Xia, Zhi-Wei, M.S, Liu, Xiao-Ming, M.S, Wang, Jun-Yu, M.D, Cao, Hui, M.S, Chen, Feng-Hua, M.D, Huang, Jun, M.D, Li, Qi-Zhuang, M.D, Fan, Shuang-Shi, M.D, Jiang, Bing, M.D, Chen, Zi-Gui, M.D, Cheng, Quan, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Clipping; Coiling; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Endovascular Procedures - standards; Female; High-grade aSAH; Humans; Male; Meta-analysis; Neurosurgery; Observational Studies as Topic - instrumentation; Observational Studies as Topic - methods; Observational Studies as Topic - standards; Randomized Controlled Trials as Topic - instrumentation; Randomized Controlled Trials as Topic - methods; Randomized Controlled Trials as Topic - standards; Ruptured intracranial aneurysms; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - surgery; Surgical Instruments - standards; Systematic review; Treatment Outcome; meta-analysis; ruptured intracranial aneurysms; clipping; high-grade aSAH; systematic review; coiling; Ruptured intracranial aneurysms; Coiling; RCTs; Clipping; High-grade aSAH; Systematic review; CARAT; SAH; WFNS; Meta-analysis; ISAT; mRS
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.11.032

Abstract Background Outcomes of coiling embolization versus clipping for patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) have not been previously compared. We reviewed the current evidence regarding the safety and efficacy of clipping versus coiling for high-grade aSAH. Methods We conducted a meta-analysis of studies that comparring clipping with coiling in patients with high-grade aSAH published from January 1999-February 2016 in Medline, Embase, and Cochrane databases based on PRISMA inclusion and exclusion criteria. Binary outcomes comparisons between clipping and coiling were described using odds ratios (ORs). Results Three randomized controlled trials (RCTs) and 16 observational studies were included. There was no statistical difference in good outcome rates between the clipping and coiling groups (OR, 1.44; 95% confidence interval [CI], 0.97-2.13). Subgroup analysis showed no significant difference between the two treatments in non-RCTs (OR, 1.49; 95% CI, 0.95-2.36) and RCTs (OR, 1.15; 95% CI, 0.59-2.25). Coiling was associated with higher mortality (OR, 0.55; 95% CI, 0.41-0.75). Lower mortality was associated with clipping in non-RCTs (OR, 0.54; 95% CI, 0.40-0.74), but there was no difference in the RCTs (OR, 0.79; 95% CI, 0.19-3.39). Coiling was not associated with lower rates of complications including rebleeding (OR, 0.62; 95% CI, 0.30-1.29), ischemic infarct (OR, 0.89; 95% CI, 0.53-1.49), symptomatic vasospasm (OR, 0.76; 95% CI, 0.45-1.29), or shunt-dependent hydrocephalus (OR, 1.33; 95% CI, 0.52-3.40). Conclusions The outcome with coiling is not superior to clipping in patients with high-grade aSAH, moreover, coiling has a greater risk of mortality.