ArticleStroke (Hoboken, N.J.)2026
Comparative Effectiveness of Surgical, Endovascular, and Conservative Strategies for Unruptured Intracranial Aneurysms.
Article in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study compares microsurgical clipping, endovascular coiling, and conservative management strategies for unruptured intracranial aneurysms using network meta-analysis to generate a treatment hierarchy that supports evidence-based decision-making.
methodsThe systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses guidelines. Eligible studies included randomized controlled trials and comparative observational cohorts of adults with unruptured intracranial aneurysms treated by clipping, coiling, or conservative observation. Primary outcomes were all-cause mortality and poor functional outcome (modified Rankin Scale score >2). Secondary outcomes included morbidity, complete aneurysm occlusion, and retreatment. A comprehensive search of PubMed, Embase, and the Cochrane Library through May 2025 identified 7 eligible studies, of which 4 provided sufficient data for network analysis.
resultsThe 4 included studies, 1 randomized trial and 3 observational cohorts, encompassed >500 patients. All compared clipping and coiling, and 2 also evaluated conservative management. Endovascular coiling ranked most favorable for reducing mortality and poor functional outcomes, though estimates were imprecise. Clipping was associated with higher morbidity than coiling but demonstrated trends toward superior anatomic durability, including higher occlusion rates and fewer retreatments. Conservative management was linked to worse survival and functional outcomes, with limited data on anatomic end points. Subgroup analyses of anterior and posterior circulation aneurysms yielded similar patterns.
conclusionsEndovascular coiling appears to offer the best short- to intermediate-term outcomes, whereas microsurgical clipping provides more durable long-term protection despite greater procedural risks. Conservative observation remains the least favorable strategy and may be reserved for highly selected low-risk patients. Further large-scale trials are needed, particularly in posterior circulation aneurysms and for patient-centered outcomes such as quality of life and cognition.
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