Efficacy and safety of endovascular coiling compared to microsurgical clipping in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of randomized trials

Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality despite advances in aneurysm repair. Microsurgical clipping and endovascular coiling are established treatment modalities, yet their relative benefits regarding functional outcome and long-term aneurysm occlusion remain debated. This study evaluates treatment effects stratified by aneurysm location and clinical grade.

We identified RCTs comparing clipping and coiling for ruptured intracranial aneurysms. Primary outcomes were favorable functional outcome at 1-year [modified Rankin Scale (mRS), and complete aneurysm occlusion at 1-year]. Secondary outcomes included location-specific analyses, WFNS grade-specific analyses, and all-cause mortality.