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

[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, I = 21%). No differences were observed compared clipping and coiling regarding occlusion rates (OR 5.3, 95%CI 0.8-36.3, I = 89%). Mortality rates did not show significant differences between treatment modalities (OR 0.97, 95%CI 0.77-1.21, I = 0%). Rebleeding rates were also similar between groups (OR 1.63, 95%CI 0.25-10.7, I = 37%); however, significantly higher retreatment rates were associated with coiling (OR 10.6, 95%CI 2.1-52.5, I = 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.