Evidence map›Paper›PMID 42587184›Full record

SynthesisNeurosurgical review2026

Untangling the debate: a meta-analysis comparing clipping versus coiling in ruptured middle cerebral artery aneurysms.

David Cho, Gerardo Duran, Cory Greer, MacGregor Thomas, Abdurrahman F Kharbat, Michael J Feldman, Andrew M Bauer, Christopher S Graffeo

Abstract readMeta-AnalysisSystematic ReviewComparative Study
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

David ChoDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
Gerardo DuranDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
Cory GreerDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
MacGregor ThomasDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
Abdurrahman F KharbatDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
Michael J FeldmanDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
Andrew M BauerDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA.
Christopher S GraffeoDepartment of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OKC, 73104, USA. Graffeo@Gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The optimal treatment strategy for ruptured middle cerebral artery (MCA) aneurysms remains debated, with microsurgical clipping offering superior occlusion and stroke rates in exchange for a more invasive experience. Although several landmark trials showed an overall benefit for coiling as compared to clipping, MCA aneurysms were underrepresented, and more granular data regarding the impact of the MCA morphology and risk factors have complicated interpretation of preceding data. We sought to perform a comprehensive contemporary meta-analysis comparing clinical and radiographic outcomes after clipping and coiling of ruptured MCA aneurysms. A PRISMA-compliant systematic review and meta-analysis was conducted using MEDLINE and EMBASE through March 2026. Studies reporting occlusion rates, clinical outcomes, and complications for both clipping and coiling in ruptured MCA aneurysms were included. Statistical analysis was performed using a random-effects model with risk ratios (RR) and odds ratios (OR) reported with 95% confidence intervals (CI). Heterogeneity was assessed via Cochran's Q test and I² statistic. A total of twelve studies met inclusion criteria, representing a total 1,309 patients (899 clipping, 410 coiling). Clipping and coiling had similar WFNS IV-V (OR = 1.32, 95%CI = 0.74-2.37, p = 0.28) and modified Fisher grade IV (OR = 1.17, 95%CI = 0.7-1.95, p = 0.47) rates at presentation. Clipping was associated with significantly higher rates of complete occlusion (Raymond-Roy grade I; RR = 1.45, 95%CI = 1.25-1.68, p < 0.0001). Retreatment rates were significantly lower following clipping (OR = 0.44, 95%CI = 0.2-0.95, p = 0.038). No significant difference was found in rates of intraoperative rupture, mRS 0-2 at discharge or 12 months, rebleeding, postoperative stroke, vasospasm, need for secondary decompressive craniectomy, shunt-dependent hydrocephalus, or mortality. Complete occlusion and retreatment outcomes for ruptured MCA aneurysm are superior after clipping as compared to coiling. Other clinical outcomes including stroke, vasospasm, or hydrocephalus, were not significantly different between treatment modalities. Given the evolving nature of endovascular techniques and the selection bias inherent to a meta-analysis of observational studies, future studies incorporating propensity-matched techniques may inform updated treatment guidelines and optimize patient outcomes.

Indexed as

Aneurysm, RupturedEmbolization, TherapeuticEndovascular ProceduresIntracranial AneurysmNeurosurgical ProceduresHumansSurgical InstrumentsTreatment OutcomeEndovascular coilingMeta-analysis as topicMicrosurgical clippingMiddle cerebral artery aneurysmSubarachnoid hemorrhageTreatment outcome

Identifiers

PMID42587184

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.