Endovascular coiling versus neurosurgical clipping for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis

Authors

Syed Ijlal Ahmed, Liaquat National Hospital and Medical College, Karachi, PAK.
Gohar Javed, Aga Khan UniversityFollow
Syeda Beenish Bareeqa, Jinnah Medical and Dental College, Karachi, PAK.
Syeda Sana Samar, Jinnah Sindh Medical University, Karachi, PAK.
Ali Shah, Dow University of Health Sciences, Karachi, PAK.
Arwa Giani, Ziauddin Medical University, Karachi, PAK.
Zainab Azam, Ziauddin Medical University, Karachi, PAK.
Abeer Tasleem, Ziauddin Medical University, Karachi, PAK.
Syed Hasham Humayun, Jinnah Medical and Dental College, Karachi, PAK.

Document Type

Article

Department

Neurosurgery

Abstract

Background: Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping.
Methods: Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software.
Results: Mortality was found to be significantly higher in the endovascular coiling group (odds ratio (OR): 1.17; confidence interval (CI): 95%, 1.04, 1.32). Re-bleeding was significantly higher in endovascular coiling (OR: 2.87; CI: 95%, 1.67, 4.93). Post-procedure complications were significantly higher in neurosurgical clipping compared to endovascular coiling (OR: 0.36; CI: 95%, 0.24, 0.56). Neurosurgical clipping was a 3.82 times better surgical technique in terms of re-bleeding (Z = 3.82, p = 0.0001). Neurosurgical clipping is a better technique requiring fewer re-treatments compared to endovascular coiling (OR: 4.64; CI: 95%, 2.31, 9.29). Endovascular coiling was found to be a better technique as it requires less rehabilitation compared to neurosurgical clipping (OR: 0.75; CI: 95%, 0.64,0.87).
Conclusion: Neurosurgical clipping provides better results in terms of mortality, re-bleeding, and re-treatments. Endovascular coiling is a better surgical technique in terms of post-operative complications, favorable outcomes, and rehabilitation.

Comments

Pagination are not provided by the author/publisher

Publication (Name of Journal)

Cureus

Recommended Citation

Ahmed, S. I., Javed, G., Bareeqa, S. B., Samar, S. S., Shah, A., Giani, A., Azam, Z., Tasleem, A., Humayun, S. H. (2019). Endovascular coiling versus neurosurgical clipping for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis. Cureus, 11(3), e4320.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurg/191

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