Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping

Objective: To compare the advantages in respect of recovery from oculomotor nerve paralysis(ONP) between endovascular coiling and surgical clipping in the treatment of cases with posterior communicating artery (PComA) aneurysms in China. Methods: By retrieving PubMed, Cochrane Library, Embase, Chinese Biomedicine Database(CMB), Chinese National Knowledge Infrastructure(CNKI) and other domestic literature database, we collect relevant studies of cases in China from 2004 to 2015. Using Review Manager (RevMan) version 5.0 software, we perform a systematic review of literature and conduct meta-analysis. Result: The meta-analysis included 12 related studies involving 712 Chinese patients with ONP secondary to PComA aneurysms, of whom 302(42.4%) were treated by endovascular coiling while 410(57.6%) received surgical clipping. Surgical clipping (298 of 410 patients, or 72.7%) resulted in greater complete recovery from ONP compared with endovascular coiling (151 of 302 patients, or 50.0%), in correspond to overall pooled odds ratio (OR) of 0.39 [confidence interval (CI) =0.19-0.83, P = 0.01]. The subgroup analysis reveal a significant benefit of surgical clipping over endovascular coiling in cases with preoperative ruptured aneurysms(P=0.01)or complete initial ONP(P=0.002). Conclusion: Better resolution of ONP with PComA aneurysms is more commonly associated with clipping than coiling, which could be especially true in the patients with preoperative ruptured aneurysms or complete initial ONP. A randomized trial including more cases is expected to elaborate this effect.

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Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature

Stroke Research and Treatment ◽

10.1155/2014/348147 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 8

Author(s):

Spiros L. Blackburn ◽

Abdelrahman M. Abdelazim ◽

Andrew B. Cutler ◽

Kevin T. Brookins ◽

Kyle M. Fargen ◽

...

Keyword(s):

Software Package ◽

Meta Analysis ◽

Endovascular Coiling ◽

Random Effects Model ◽

Review Of The Literature ◽

Surgical Clipping ◽

Statistical Software ◽

Pubmed Search ◽

Occlusion Rate

Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling.Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran’sQtest was used to evaluate possible heterogeneity among the rates observed in each study.Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group (P<0.05). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling (P<0.05). The recanalization rate was 0% for clipping and 14.3% for coiling (P=0.05). Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS).Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.

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Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2016.11.jns162055 ◽

2018 ◽

Vol 128 (3) ◽

pp. 768-776 ◽

Cited By ~ 4

Author(s):

Peter Egeto ◽

R. Loch Macdonald ◽

Tisha J. Ornstein ◽

Tom A. Schweizer

Keyword(s):

Older Patients ◽

Neuropsychological Functioning ◽

Meta Analysis ◽

Posterior Circulation ◽

Effect Sizes ◽

Group Differences ◽

Endovascular Coiling ◽

Healthy Controls ◽

Surgical Clipping ◽

Influence Effect

OBJECTIVESubarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. They hypothesized that the coiled patients would outperform the clipped patients; that group differences would be greater with higher posterior circulation rupture rates, in older patients, and in more recent publications; that group differences would be smaller with greater rates of middle cerebral artery (MCA) rupture; and that anterior communicating artery (ACoA) rupture rates would not influence effect sizes.METHODSThe MEDLINE, Embase, and PsycINFO databases were searched for clinical studies that compared neuropsychological functioning after either endovascular coiling or surgical clipping for SAH. Hedge's g and 95% confidence intervals were calculated using random effects models. Patients who had undergone coiling or clipping were compared on test performance in 8 neuropsychological domains: executive functions, language, attention/processing speed, verbal memory, visual memory, spatial memory, visuospatial functions, and intelligence. Patients were also compared with healthy controls, and meta-regressions were used to explore the relation between effect sizes and publication year, delay between treatment and neuropsychological testing, mean patient age, and rates of posterior circulation, ACoA, and MCA ruptures.RESULTSThirteen studies with 396 clipped cases, 314 coiled cases, and 169 healthy controls were included in the study. The coil-treated patients outperformed the clip-treated patients on executive function (g = 0.17, 95% CI 0.08–0.25) and language tests (g = 0.23, 95% CI 0.07–0.39), and all patients were impaired relative to healthy controls (g ranged from −0.93 to −0.29). Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes.CONCLUSIONSCoiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.

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The costs of endovascular coiling for aneurysmal subarachnoid haemorrhage are similar to those of surgical clipping,

PharmacoEconomics & Outcomes News ◽

10.2165/00151234-200805460-00022 ◽

2008 ◽

Vol 546 (1) ◽

pp. 8-8

Keyword(s):

Subarachnoid Haemorrhage ◽

Endovascular Coiling ◽

Aneurysmal Subarachnoid Haemorrhage ◽

Surgical Clipping

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Level of headaches after surgical aneurysm clipping decreases significantly faster compared to endovascular coiled patients

Clinics and Practice ◽

10.4081/cp.2017.936 ◽

2017 ◽

Vol 7 (2) ◽

Cited By ~ 1

Author(s):

Athanasios K. Petridis ◽

Jan F. Cornelius ◽

Marcel A. Kamp ◽

Sina Falahati ◽

Igor Fischer ◽

...

Keyword(s):

Aneurysm Rupture ◽

Endovascular Coiling ◽

Analog Scale ◽

Surgical Clipping ◽

Time Points ◽

Ruptured Aneurysms ◽

Aneurysm Clipping ◽

Incidental Aneurysms ◽

The Difference ◽

Late Recovery

In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical clipping vs. endovascular coiling in concern to post-procedural headaches in patients with ruptured aneurysms. Sixtyseven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1st 2015 - September 1st 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or highgrade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS) for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant). Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.

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