Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

Timothy R. Smith, David J. Cote, Hormuzdiyar H. Dasenbrock, Youssef J. Hamade, Samer G. Zammar, Najib E. El Tecle, H. Hunt Batjer, Bernard Bendok

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. Methods Literature was reviewed for all studies reporting angiographic occlusion and/or functional outcomes in adults with unruptured MCAA treated by endovascular coiling or microsurgical clipping. All studies in English that reported results for adults (≥18 years) with unruptured MCAAs, from 1990 to 2011 were considered for inclusion. Results Twenty-six studies involving 2295 aneurysms treated with clipping or coiling for unruptured MCAAs were included for analysis. There were 1530 aneurysms that were treated with clipping and 765 aneurysms treated with coiling. Pooled analysis revealed failure of aneurysmal occlusion in 3.0% (95% confidence interval [CI] 1.2%-7.4%) of clipped cases. Pooled analysis of 15 studies (606 aneurysms) involving coiling and occlusion revealed lack of occlusion rates of 47.7% (95% CI 43.6%-51.8%) with the fixed-effects model and 48.2% (95% CI 39.0%-57.4%) with the random-effects model. Thirteen studies examined neurological outcomes after clipping and were pooled for analysis. Both fixed-effect and random-effect models revealed unfavorable outcomes in 2.1% (95% CI 1.3%-3.3%) of patients. There were 17 studies evaluating potential unfavorable neurological outcomes after coiling that were pooled for analysis. Fixed-effect and random-effect models revealed unfavorable outcomes in 6.5% (95% CI 4.5%-9.3%) and 4.9% (95% CI 3.0%-8.1%) of patients, respectively. Conclusions Based on this systematic review and meta-analysis of unruptured MCAAs, after careful consideration of patient, aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured MCAA.

Original languageEnglish (US)
Pages (from-to)942-953
Number of pages12
JournalWorld Neurosurgery
Volume84
Issue number4
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

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Intracranial Aneurysm
Meta-Analysis
Confidence Intervals
Safety
Aneurysm

Keywords

  • Aneurysm
  • Clipping
  • Coiling
  • Endovascular
  • MCA aneurysm
  • Meta-analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms : A Systematic Review and Meta-Analysis. / Smith, Timothy R.; Cote, David J.; Dasenbrock, Hormuzdiyar H.; Hamade, Youssef J.; Zammar, Samer G.; El Tecle, Najib E.; Batjer, H. Hunt; Bendok, Bernard.

In: World Neurosurgery, Vol. 84, No. 4, 01.10.2015, p. 942-953.

Research output: Contribution to journalArticle

Smith, Timothy R. ; Cote, David J. ; Dasenbrock, Hormuzdiyar H. ; Hamade, Youssef J. ; Zammar, Samer G. ; El Tecle, Najib E. ; Batjer, H. Hunt ; Bendok, Bernard. / Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms : A Systematic Review and Meta-Analysis. In: World Neurosurgery. 2015 ; Vol. 84, No. 4. pp. 942-953.
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abstract = "Objective Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. Methods Literature was reviewed for all studies reporting angiographic occlusion and/or functional outcomes in adults with unruptured MCAA treated by endovascular coiling or microsurgical clipping. All studies in English that reported results for adults (≥18 years) with unruptured MCAAs, from 1990 to 2011 were considered for inclusion. Results Twenty-six studies involving 2295 aneurysms treated with clipping or coiling for unruptured MCAAs were included for analysis. There were 1530 aneurysms that were treated with clipping and 765 aneurysms treated with coiling. Pooled analysis revealed failure of aneurysmal occlusion in 3.0{\%} (95{\%} confidence interval [CI] 1.2{\%}-7.4{\%}) of clipped cases. Pooled analysis of 15 studies (606 aneurysms) involving coiling and occlusion revealed lack of occlusion rates of 47.7{\%} (95{\%} CI 43.6{\%}-51.8{\%}) with the fixed-effects model and 48.2{\%} (95{\%} CI 39.0{\%}-57.4{\%}) with the random-effects model. Thirteen studies examined neurological outcomes after clipping and were pooled for analysis. Both fixed-effect and random-effect models revealed unfavorable outcomes in 2.1{\%} (95{\%} CI 1.3{\%}-3.3{\%}) of patients. There were 17 studies evaluating potential unfavorable neurological outcomes after coiling that were pooled for analysis. Fixed-effect and random-effect models revealed unfavorable outcomes in 6.5{\%} (95{\%} CI 4.5{\%}-9.3{\%}) and 4.9{\%} (95{\%} CI 3.0{\%}-8.1{\%}) of patients, respectively. Conclusions Based on this systematic review and meta-analysis of unruptured MCAAs, after careful consideration of patient, aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured MCAA.",
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T1 - Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms

T2 - A Systematic Review and Meta-Analysis

AU - Smith, Timothy R.

AU - Cote, David J.

AU - Dasenbrock, Hormuzdiyar H.

AU - Hamade, Youssef J.

AU - Zammar, Samer G.

AU - El Tecle, Najib E.

AU - Batjer, H. Hunt

AU - Bendok, Bernard

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Objective Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. Methods Literature was reviewed for all studies reporting angiographic occlusion and/or functional outcomes in adults with unruptured MCAA treated by endovascular coiling or microsurgical clipping. All studies in English that reported results for adults (≥18 years) with unruptured MCAAs, from 1990 to 2011 were considered for inclusion. Results Twenty-six studies involving 2295 aneurysms treated with clipping or coiling for unruptured MCAAs were included for analysis. There were 1530 aneurysms that were treated with clipping and 765 aneurysms treated with coiling. Pooled analysis revealed failure of aneurysmal occlusion in 3.0% (95% confidence interval [CI] 1.2%-7.4%) of clipped cases. Pooled analysis of 15 studies (606 aneurysms) involving coiling and occlusion revealed lack of occlusion rates of 47.7% (95% CI 43.6%-51.8%) with the fixed-effects model and 48.2% (95% CI 39.0%-57.4%) with the random-effects model. Thirteen studies examined neurological outcomes after clipping and were pooled for analysis. Both fixed-effect and random-effect models revealed unfavorable outcomes in 2.1% (95% CI 1.3%-3.3%) of patients. There were 17 studies evaluating potential unfavorable neurological outcomes after coiling that were pooled for analysis. Fixed-effect and random-effect models revealed unfavorable outcomes in 6.5% (95% CI 4.5%-9.3%) and 4.9% (95% CI 3.0%-8.1%) of patients, respectively. Conclusions Based on this systematic review and meta-analysis of unruptured MCAAs, after careful consideration of patient, aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured MCAA.

AB - Objective Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. Methods Literature was reviewed for all studies reporting angiographic occlusion and/or functional outcomes in adults with unruptured MCAA treated by endovascular coiling or microsurgical clipping. All studies in English that reported results for adults (≥18 years) with unruptured MCAAs, from 1990 to 2011 were considered for inclusion. Results Twenty-six studies involving 2295 aneurysms treated with clipping or coiling for unruptured MCAAs were included for analysis. There were 1530 aneurysms that were treated with clipping and 765 aneurysms treated with coiling. Pooled analysis revealed failure of aneurysmal occlusion in 3.0% (95% confidence interval [CI] 1.2%-7.4%) of clipped cases. Pooled analysis of 15 studies (606 aneurysms) involving coiling and occlusion revealed lack of occlusion rates of 47.7% (95% CI 43.6%-51.8%) with the fixed-effects model and 48.2% (95% CI 39.0%-57.4%) with the random-effects model. Thirteen studies examined neurological outcomes after clipping and were pooled for analysis. Both fixed-effect and random-effect models revealed unfavorable outcomes in 2.1% (95% CI 1.3%-3.3%) of patients. There were 17 studies evaluating potential unfavorable neurological outcomes after coiling that were pooled for analysis. Fixed-effect and random-effect models revealed unfavorable outcomes in 6.5% (95% CI 4.5%-9.3%) and 4.9% (95% CI 3.0%-8.1%) of patients, respectively. Conclusions Based on this systematic review and meta-analysis of unruptured MCAAs, after careful consideration of patient, aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured MCAA.

KW - Aneurysm

KW - Clipping

KW - Coiling

KW - Endovascular

KW - MCA aneurysm

KW - Meta-analysis

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