SynthesisJournal of neurology2026
Efficacy and safety of endovascular coiling compared to microsurgical clipping in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of randomized trials.
Synthesis in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
backgroundAneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality despite advances in aneurysm repair. Microsurgical clipping and endovascular coiling are established treatment modalities, yet their relative benefits regarding functional outcome and long-term aneurysm occlusion remain debated. This study evaluates treatment effects stratified by aneurysm location and clinical grade.
methodsWe identified RCTs comparing clipping and coiling for ruptured intracranial aneurysms. Primary outcomes were favorable functional outcome at 1-year [modified Rankin Scale (mRS), and complete aneurysm occlusion at 1-year]. Secondary outcomes included location-specific analyses, WFNS grade-specific analyses, and all-cause mortality.
resultsSix RCTs involving up to 3044 patients were included. Coiling was associated with higher odds of favorable outcome at 1 year using mRS 0-2 (OR 1.60, 95% CI 1.36-1.88; p < 0.00001), but not when using mRS 0-3 (OR 1.19, p = 0.12). Location-specific analyses showed better outcomes after coiling for internal carotid artery aneurysms (OR 0.44, p < 0.00001), no difference for anterior communicating, anterior cerebral, middle cerebral, or posterior circulation aneurysms. Complete occlusion at 12 months favored clipping overall (OR 0.35, 95% CI 0.28-0.44; p < 0.00001; I
conclusionsCoiling offers superior 1-year functional outcomes when assessed with mRS 0-2, while clipping achieves higher complete occlusion rates, predominantly in middle cerebral artery aneurysms. No mortality difference was found.
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