Author(s): Li H, Pan R, Wang H, Rong X, Yin Z, et al.
Background and purpose: Endovascular treatment has increasingly been used for aneurismal subarachnoid aneurismal hemorrhage. The aim of this analysis is to assess the current evidence regarding safety and efficiency of clipping compared with coiling.
Methods: We conducted a meta-analysis of studies that compared clipping with coiling between January 1999 and July 2012. Comparison of binary outcomes between treatment groups was described using odds ratios (OR; clip versus coil).
Results: Four randomized controlled trials and 23 observational studies were included. Randomized controlled trials showed that coiling reduced the 1-year unfavorable outcome rate (OR, 1.48; 95% confidence interval [CI], 1.24-1.76). However, there was no statistical deference in nonrandomized controlled trials (OR, 1.11; 95% CI, 0.96-1.28). Subgroup analysis revealed coiling yielded better outcomes for patients with good preoperative grade (OR, 1.51; 95% CI, 1.24-1.84) than for poor preoperative patients (OR, 0.88; 95% CI 0.56-1.38). Additionally, the incidence of rebleeding is higher after coiling (OR, 0.43; 95% CI, 0.28-0.66), corresponding to a better complete occlusion rate of clipping (OR, 2.43; 95% CI, 1.88-3.13). The 1-year mortality showed no significant difference (OR, 1.07; 95% CI, 0.88-1.30). Vasospasm was more common after clipping (OR, 1.43; 95% CI, 1.07-1.91), whereas the ischemic infarct (OR, 0.74; 95% CI, 0.52-1.06), shunt-dependent hydrocephalus (OR, 0.84; 95% CI, 0.66-1.07), and procedural complication rates (OR, 1.19; 95% CI, 0.67-2.11) did not differ significantly between techniques.
Conclusions: Coiling yields a better clinical outcome, the benefit being greater in those with a good preoperative grade than those with a poor preoperative grade. However, coiling leads to a greater risk of rebleeding. Well-designed randomized trials with special considerations to the aspect are needed.
Referred From: https://www.ncbi.nlm.nih.gov/pubmed/23238862
Author(s): Schievink WI
Author(s): Choi SS, Jeon SJ
Author(s): Zubair Tahir M, Enam SA, Pervez Ali R, Bhatti A, ul Haq T
Author(s): Natarajan SK, Sekhar LN, Ghodke B, Britz GW, Bhagawati D, et al.
Author(s): de Oliveira JG, Beck J, Ulrich C, Rathert J, Raabe A, et al.
Author(s): Im SH, Han MH, Kwon OK, Kwon BJ, Kim SH, et al.
Author(s): Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, et al.
Author(s): Hamid RS, Haq T, Chishti I, Azeemuddin M, Sajjad Z, Salam B
Author(s): Wijdicks EF, Kallmes DF, Manno EM, Fulgham JR, Piepgras DG
Author(s): Johnston SC, Selvin S, Gress DR
Author(s): Soni D
Author(s): Lanzino G, Murad MH, dUrso PI, Rabinstein A
Author(s): Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M et al.
Author(s): Dorhout Mees SM, Kerr RS, Rinkel GJ, Algra A, Molyneux AJ
Author(s): Vergouwen MD, Fang J, Casaubon LK, Stamplecoski M, Robertson A
Author(s): Lindsay KW, Bone I, Fuller G, Callander R, Gijin JV
Author(s): J Lafuente, Maurice-Williams RS
Author(s): Frosch MP, Anthony DC, Girolami UD
Author(s): Darsaut TE, Kotowski M, Raymond J
Author(s): Platt ML, Huettel SA
Author(s): Hoh BL, Chi YY, Dermott MA, Lipori PJ, Lewis SB
Author(s): Kaku Y, Yamashita K, Kokuzawa J, Hatsuda N, Andoh T
Author(s): Birski M, Walesa C, Gaca W, Paczkowski D, Birska J, et al.
Author(s): Bohman L, Winn H, LeRoux P