Turkish Neurosurgery
Systematic review of treatment for unruptured intracranial aneurysms: clipping vs coiling
shen zhe1, zhao yachao1, gu xuanmin1, fang junchao1, yang jinsheng1, li tao1, fan bo1
1the first affiliated hospital of henan university of science and technologe, neurosurgery, luoyang,
DOI: 10.5137/1019-5149.JTN.23729-18.1

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.

Corresponding author : fan bo