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Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and meta-analysis of randomized controlled trials

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A Correction to this article was published on 11 June 2022

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Abstract

Introduction

Previous meta-analyses comparing microsurgery and coiling that include BRAT may be inaccurate to compare the outcomes of ruptured saccular aneurysms. This study aims to evaluate 10-year efficiency, safety, and advantages of coiling compared with clipping in patients with spontaneous saccular aneurismal SAH as a primary outcome. Also analyzed secondary outcomes: no-occlusion, mortality, rebleeding, and retreatment.

Methods

A systematic search of the literature on microsurgical clipping versus coiling was done to identify RCTs with at least 10 years of follow-up published between 2000 and 2021. The primary outcome was favorable functional outcome, defined as a modified Rankin scale (mRS) score ≤ 2. Secondary outcomes were no-occlusion, mortality, rebleeding, and retreatment. Quality of the included trials was analyzed using the Risk of Bias 2.0 (RoB 2.0) tool. A random-effects meta-analysis was performed.

Results

Two studies reported 10-year follow-up results, and the meta-analysis did not demonstrate significant differences between groups (OR 0.9, 95%CI 0.66–1.24, I2 = 21%). No differences were observed compared clipping and coiling regarding occlusion rates (OR 5.3, 95%CI 0.8–36.3, I2 = 89%). Mortality rates did not show significant differences between treatment modalities (OR 0.97, 95%CI 0.77–1.21, I2 = 0%). Rebleeding rates were also similar between groups (OR 1.63, 95%CI 0.25–10.7, I2 = 37%); however, significantly higher retreatment rates were associated with coiling (OR 10.6, 95%CI 2.1–52.5, I2 = 80%). Overall, risk of bias was low.

Conclusion

There are no long-term differences regarding no-occlusion, mortality, and rebleeding rates between coiling and clipping. Higher retreatment rates were associated with coiling.

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Acknowledgements

This research project was approved by the Ethics and Research Committee of Hospital das Clinicas, FMUSP (HCFMUSP) (Online registration CAPPesq: 15226 approved 06/20/2016) and on the Brazil Platform of the Misnitry of Health (CAAE number: 61719416.6.0000.0068).

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Authors and Affiliations

  1. Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil

    Nicollas Nunes Rabelo, João Paulo Mota Telles, Leonardo Zumerkorn Pipek, Manoel Jacobsen Teixeira & Eberval Gadelha Figueiredo

  2. School of Medicine, Federal University of Amazonas, Manaus, Brazil

    Louise Makarem

  3. Department of Parasitology, Federal University of Amazonas, Manaus, Brazil

    Antonio Luis Boechat

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  1. Nicollas Nunes Rabelo
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Contributions

NNR, JPMT, and LZP were responsible for study selection and drafting the manuscript. JPMT was responsible for statistical analyses. MJT, LM, and ALB were responsible for coordination, supervision, and revision of the final draft. EGF was responsible for study design, supervision, and revision of the final draft.

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Correspondence to Nicollas Nunes Rabelo.

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The authors declare no competing interests.

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Ethical approval by the local IRB was waived due to the nature of the study.

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The original online version of this article was revised: Originally, the article contains an error in Figure 5. All numbers, comparisons and results are already correct in the article text/body (results and discussion). However, the figure uploaded was an old version with incorrect data. The figure is now updated.

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Rabelo, N.N., Telles, J.P.M., Pipek, L.Z. et al. Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and meta-analysis of randomized controlled trials. Neurol Sci 43, 4909–4915 (2022). https://doi.org/10.1007/s10072-022-06039-2

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