Treatment of Unruptured Cerebral Artery Aneurysm: A Meta-Analysis

Life Sciences-Neuro surgery for better health care

Abstract

Unruptured   middle  cerebral  artery  (MCA) aneurysms  can  be  treated   using  two  techniques  or  procedures, microsurgical clipping  and endovascular coiling. The aim of this meta-analysis study is  to  compare  the  safety and efficacy of microsurgical clipping with the endovascular coiling in the treatment  of unruptured  MCA aneurysms. We  searched  electronic databases (PubMed, EMBASE and the Cochrane  library) to identify studies published  between  1991 and 2019. For clipping and coiling techniques, separate meta-analyses were conducted on efficacy and safety after the intervention and at follow-up by using random- and fixed-effects  models.  Forty-one articles  were  included  in our  meta-analyses:  23 case series  using clipping and 25 case series  using coiling procedures.  The complete  aneurysm occlusion  rate was higher in the clipping procedure  (96.1%, 95% CI: 92.8%-97.9%) as compared to the coiling procedure  (57.6%, 95% CI: 49.4 – 65.4%). Clipping procedure  has a slightly higher rate  of  favorable  functional  outcomes  (96.4%,  95% CI: 94.8 – 97.5%) compared  to  coiling procedure  (94.8%,  95% CI:  93.1 –96%). Interestingly, the rate of occlusion appears to decrease with time in the clipping group and increase with time in the coiling group, while  the rate  of  favorable  functional outcomes  appears to increase  with  time  in the clipping group and decrease  with time in the coiling group. Publication bias was unlikely in all our analysis for studies assessing: coiling and occlusion rate, clipping and occlusion rate, coiling and functional outcomes, and clipping and functional outcomes. Microsurgical clipping yields a higher aneurysm occlusion  rate,  with  slightly  higher favorable  functional  outcomes  in the  treatment  of  unruptured  MCA aneurysms than the endovascular coiling.