E-ISSN: 1019-5157
ISSN: 2651-5024
Review
Systematic review of treatment for unruptured intracranial aneurysms: clipping vs coiling
shen zhe✉ ,
zhao yachao ,
gu xuanmin ,
fang junchao ,
yang jinsheng ,
li tao ,
fan bo
Corresponding Author:
shen zhe (shenzhe2016@yahoo.com)
Abstract
Background: In recent years, unruptured intracranial aneurysms have been found more frequently, and endovascular coiling has become an increasingly popular treatment.
Methods: Computer databases were searched between 1990 and 2018; the databases included Medline, EMBASE, the Cochrane library, and three Chinese domestic databases. We included controlled clinical studies. Two researchers extracted data and assessed the included studies. A meta-analysis was performed.
Results: We analysed 23 studies including 117796 cases. A meta-analysis showed similar ischaemia rates between clipping and coiling (OR=1.36, 95%CI: 0.77-2.40). The occlusion rate and bleeding risk with clipping were higher than coiling; the OR were 5.31 (95%CI: 3.07-9.19) and 2.39 (95%CI: 1.82-3.13). In addition, clipping resulted in a longer hospital stay (OR=2.90, 95%CI: 2.14-3.65) than did coiling. Patients who underwent clipping had a higher short-term mortality (OR=1.99, 95%CI: 1.70-2.33) and deficit rate (OR=2.05, 95%CI: 1.73-2.44) compared with patients underwent coiling. However, 1 year mortality and deficit rate showed similar levels for both clipping and coiling; OR=0.75 (95%CI: 0.41-1.38) and 0.94 (95%CI: 0.53-1.67). Funnel plots did not find publication bias. Sensitivity analysis showed consistent results.
Conclusion: The study showed that coiling was associated with a lower occlusion rate, shorter hospital stay, lower bleeding risk, and lower short-term mortality and morbidity compared to clipping. In terms of ischemia risk, 1 year mortality and morbidity, coiling and clipping bear similar risk. We suppose that clipping may have a better outcome than coiling in the long term especially for young patients. Further research is needed to confirm our conclusion.
Methods: Computer databases were searched between 1990 and 2018; the databases included Medline, EMBASE, the Cochrane library, and three Chinese domestic databases. We included controlled clinical studies. Two researchers extracted data and assessed the included studies. A meta-analysis was performed.
Results: We analysed 23 studies including 117796 cases. A meta-analysis showed similar ischaemia rates between clipping and coiling (OR=1.36, 95%CI: 0.77-2.40). The occlusion rate and bleeding risk with clipping were higher than coiling; the OR were 5.31 (95%CI: 3.07-9.19) and 2.39 (95%CI: 1.82-3.13). In addition, clipping resulted in a longer hospital stay (OR=2.90, 95%CI: 2.14-3.65) than did coiling. Patients who underwent clipping had a higher short-term mortality (OR=1.99, 95%CI: 1.70-2.33) and deficit rate (OR=2.05, 95%CI: 1.73-2.44) compared with patients underwent coiling. However, 1 year mortality and deficit rate showed similar levels for both clipping and coiling; OR=0.75 (95%CI: 0.41-1.38) and 0.94 (95%CI: 0.53-1.67). Funnel plots did not find publication bias. Sensitivity analysis showed consistent results.
Conclusion: The study showed that coiling was associated with a lower occlusion rate, shorter hospital stay, lower bleeding risk, and lower short-term mortality and morbidity compared to clipping. In terms of ischemia risk, 1 year mortality and morbidity, coiling and clipping bear similar risk. We suppose that clipping may have a better outcome than coiling in the long term especially for young patients. Further research is needed to confirm our conclusion.
Keywords
unruptured intracranial aneurysms
surgical clipping
endovascular coiling
systematic review