Vol. 9, Issue 3, Part B (2025)

Background: There are many debates regarding endovascular coiling versus microsurgical clipping for ruptured intracranial aneurysms. We conducted a systemic review and a meta-analysis in order to determine the clinical and angiographic outcomes associated with each treatment in the long run. Methods: We aimed to collect RCT and prospective cohort/registry studies comparing endovascular coiling and microsurgical clipping for ruptured saccular intracranial aneurysms from the databases of PubMed/Medline, Embase, and central. The primary outcome was a poor functional outcome, as defined by having a modified Rankin Scale score greater than 2, at approximately 12 months. Secondary outcomes included retreatment, mortality, rebleeding, and angiographic occlusion. Data selection and extraction and risk of bias assessments was performed in accordance with PRISMA methodology. The risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: There were six studies that fulfilled the inclusion criteria which included 2 RCTs (ISAT and BRAT) and 4 prospective cohort/registry studies with a total of 6671 patients. In the pooled analysis of the two RCTs, endovascular coiling associated with a significantly lower risk of poor functional outcome at ~12 months compared with microsurgical clipping (RR 0.78, 95% CI 0.68-0.89; I2 = 12%). Retreatment occurred after endovascular coiling substantially more frequently, with pooled data from trials and registries showing approximately 4-fold increased risk (RR 3.90, 95% CI 2.80-5.50; I2 = 10%). All-cause mortality rates had no clear difference at 1 year between the techniques (RR 0.95, 95% CI 0.76-1.18). Rebleeding events were generally rare, but did happen frequently more often after coiling. Conclusion: Choosing the right treatment should be individualized, weighing the immediate benefits of coiling against the longer-lasting effectiveness of clipping. More research is needed to assess outcomes with modern endovascular techniques and to better understand the long-term effects on patients and the economic implications.