Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy.
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| Title: | Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy. |
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| Authors: | Hammed, Ali (AUTHOR), Al-Qiami, Almonzer (AUTHOR), Alomari, Omar (AUTHOR), Otmani, Zina (AUTHOR), Hammed, Salah (AUTHOR), Sarhan, Khalid (AUTHOR), Derhab, Mohamed (AUTHOR), Hamouda, Abdelrahman (AUTHOR), Rosenbauer, Josef (AUTHOR), Kostev, Karel (AUTHOR), Richter, Gregor (AUTHOR), Braun, Veit (AUTHOR), Tanislav, Christian (AUTHOR) |
| Source: | Neurological Sciences. Jun2025, Vol. 46 Issue 6, p2499-2522. 24p. |
| Subjects: | Intracranial aneurysms, Subarachnoid hemorrhage, Medical sciences, Ischemic stroke, Health equity |
| Abstract: | Background: Surgical clipping and endovascular coiling are both effective in preventing aneurysmal subarachnoid hemorrhage, but the choice between these interventions remains controversial, leading to treatment disparities across medical centers. Methods: A systematic review and meta-analysis were conducted, including relevant two-arm clinical trials up to September 2023, sourced from Scopus, PubMed, Web of Science, and the Cochrane Library. Our primary outcomes were complete occlusion rates during mid-term and long-term follow-ups. Standard mean differences and risk ratios were used to analyze variations in outcomes. Python meta-analysis with sensitivity testing and regional subgroup analysis was used to resolve heterogeneity. Results: The analysis included 139,485 participants. Clipping demonstrated significantly higher complete occlusion rates in midterm follow-up (RR = 0.83, 95% CI [0.75, 0.91], p = 0.0001) but was associated with a higher risk of procedural complications such as bleeding and ischemic stroke. Coiling showed a higher risk of retreatment (RR = 3.46, 95% CI [1.21, 9.86], p = 0.02), yet it had lower procedural complications (RR = 0.54, 95% CI [0.38, 0.78], p < 0.0009), shorter hospital stays (MD 4.36, 95% CI [2.96, 5.77], p = 0.0001), and better post-procedural outcomes as indicated by lower modified Rankin Scale scores (RR = 0.73, 95% CI [0.55, 0.97], p = 0.03). Long-term occlusion rates were comparable between the two methods. Conclusion: While clipping achieves higher mid-term occlusion rates, coiling is associated with fewer complication rates, shorter hospital stays, and potentially better long-term outcomes. Treatment decisions should be individualized, considering patient-specific characteristics and procedural feasibility. [ABSTRACT FROM AUTHOR] |
| Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 185240168 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Hammed%2C+Ali%22">Hammed, Ali</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Al-Qiami%2C+Almonzer%22">Al-Qiami, Almonzer</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Alomari%2C+Omar%22">Alomari, Omar</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Otmani%2C+Zina%22">Otmani, Zina</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hammed%2C+Salah%22">Hammed, Salah</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sarhan%2C+Khalid%22">Sarhan, Khalid</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Derhab%2C+Mohamed%22">Derhab, Mohamed</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hamouda%2C+Abdelrahman%22">Hamouda, Abdelrahman</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rosenbauer%2C+Josef%22">Rosenbauer, Josef</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kostev%2C+Karel%22">Kostev, Karel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Richter%2C+Gregor%22">Richter, Gregor</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Braun%2C+Veit%22">Braun, Veit</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tanislav%2C+Christian%22">Tanislav, Christian</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Neurological+Sciences%22">Neurological Sciences</searchLink>. Jun2025, Vol. 46 Issue 6, p2499-2522. 24p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Intracranial+aneurysms%22">Intracranial aneurysms</searchLink><br /><searchLink fieldCode="DE" term="%22Subarachnoid+hemorrhage%22">Subarachnoid hemorrhage</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+sciences%22">Medical sciences</searchLink><br /><searchLink fieldCode="DE" term="%22Ischemic+stroke%22">Ischemic stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Health+equity%22">Health equity</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background: Surgical clipping and endovascular coiling are both effective in preventing aneurysmal subarachnoid hemorrhage, but the choice between these interventions remains controversial, leading to treatment disparities across medical centers. Methods: A systematic review and meta-analysis were conducted, including relevant two-arm clinical trials up to September 2023, sourced from Scopus, PubMed, Web of Science, and the Cochrane Library. Our primary outcomes were complete occlusion rates during mid-term and long-term follow-ups. Standard mean differences and risk ratios were used to analyze variations in outcomes. Python meta-analysis with sensitivity testing and regional subgroup analysis was used to resolve heterogeneity. Results: The analysis included 139,485 participants. Clipping demonstrated significantly higher complete occlusion rates in midterm follow-up (RR = 0.83, 95% CI [0.75, 0.91], p = 0.0001) but was associated with a higher risk of procedural complications such as bleeding and ischemic stroke. Coiling showed a higher risk of retreatment (RR = 3.46, 95% CI [1.21, 9.86], p = 0.02), yet it had lower procedural complications (RR = 0.54, 95% CI [0.38, 0.78], p < 0.0009), shorter hospital stays (MD 4.36, 95% CI [2.96, 5.77], p = 0.0001), and better post-procedural outcomes as indicated by lower modified Rankin Scale scores (RR = 0.73, 95% CI [0.55, 0.97], p = 0.03). Long-term occlusion rates were comparable between the two methods. Conclusion: While clipping achieves higher mid-term occlusion rates, coiling is associated with fewer complication rates, shorter hospital stays, and potentially better long-term outcomes. Treatment decisions should be individualized, considering patient-specific characteristics and procedural feasibility. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=185240168 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10072-024-07963-1 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 24 StartPage: 2499 Subjects: – SubjectFull: Intracranial aneurysms Type: general – SubjectFull: Subarachnoid hemorrhage Type: general – SubjectFull: Medical sciences Type: general – SubjectFull: Ischemic stroke Type: general – SubjectFull: Health equity Type: general Titles: – TitleFull: Preventive clipping versus coiling in unruptured intracranial aneurysms: A comprehensive meta-analysis and systematic review to explore safety and efficacy. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Hammed, Ali – PersonEntity: Name: NameFull: Al-Qiami, Almonzer – PersonEntity: Name: NameFull: Alomari, Omar – PersonEntity: Name: NameFull: Otmani, Zina – PersonEntity: Name: NameFull: Hammed, Salah – PersonEntity: Name: NameFull: Sarhan, Khalid – PersonEntity: Name: NameFull: Derhab, Mohamed – PersonEntity: Name: NameFull: Hamouda, Abdelrahman – PersonEntity: Name: NameFull: Rosenbauer, Josef – PersonEntity: Name: NameFull: Kostev, Karel – PersonEntity: Name: NameFull: Richter, Gregor – PersonEntity: Name: NameFull: Braun, Veit – PersonEntity: Name: NameFull: Tanislav, Christian IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 06 Text: Jun2025 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 15901874 Numbering: – Type: volume Value: 46 – Type: issue Value: 6 Titles: – TitleFull: Neurological Sciences Type: main |
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