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01.04.2022 | Original Article

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

verfasst von: Nicollas Nunes Rabelo, João Paulo Mota Telles, Leonardo Zumerkorn Pipek, Louise Makarem, Antonio Luis Boechat, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo

Erschienen in: Neurological Sciences | Ausgabe 8/2022

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Abstract

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, I² = 21%). No differences were observed compared clipping and coiling regarding occlusion rates (OR 5.3, 95%CI 0.8–36.3, I² = 89%). Mortality rates did not show significant differences between treatment modalities (OR 0.97, 95%CI 0.77–1.21, I² = 0%). Rebleeding rates were also similar between groups (OR 1.63, 95%CI 0.25–10.7, I² = 37%); however, significantly higher retreatment rates were associated with coiling (OR 10.6, 95%CI 2.1–52.5, I² = 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.

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Titel: Long-term outcomes of ruptured saccular intracranial aneurysm clipping versus coiling: systematic review and meta-analysis of randomized controlled trials
verfasst von: Nicollas Nunes Rabelo
João Paulo Mota Telles
Leonardo Zumerkorn Pipek
Louise Makarem
Antonio Luis Boechat
Manoel Jacobsen Teixeira
Eberval Gadelha Figueiredo
Publikationsdatum: 01.04.2022
Verlag: Springer International Publishing
Erschienen in: Neurological Sciences / Ausgabe 8/2022
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-022-06039-2

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