Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

Abstract

Background: Posterior circulation intracranial aneurysm (IA) treatment remains challenging, due to the anatomy of the area and the high rupture possibility. Endovascular treatment seems to be more suitable for these aneurysms, but studies focused on endovascular treatment demonstrate a high rate of re-intervention needing. A meta-analysis might offer a clearer view, being useful in a more effective treatment planning. Methods: A systematic search was performed, using the PubMed database platform. The final article pool contained 20 articles. Studied parameters were operative mortality, late mortality, permanent neurologic deficit (PND), and the need for re-intervention (Re-int). We divided patients into two subgroups, those with ruptured and those with unruptured aneurysm. Statistical analysis was performed using appropriate software. Results: In the total population (645 patients), there was a superiority of coiling over clipping in terms of PND and of coiling in terms of Re-int. As regards mortality, there was no clear superiority of one method over the other. Conclusions: The current study came to the conclusion that there is a superiority of coiling over clipping in terms of PND. On the other hand, clipping seems to be superior to coiling in terms of the need for re-intervention. As regards mortality (both operative and late), there is no clear superiority of one method over the other. Studying subgroups of patients (ruptured and unruptured posterior circulation IAs), in terms of PND, there is no superiority of one method over the other. The same goes for Op-Mo on ruptured aneurysms.

Unruptured Posterior Cerebral Artery Aneurysm Presenting with Temporal Lobe Epilepsy

“…However, the choice of treatment modality ought to consider factors including patient characteristics, aneurysm morphology and location, and physician expertise. 11 This case report adds to the limited literature describing unruptured PCA aneurysms presenting with seizures. This patient was significantly older than previous cases, and he experienced focal aware seizures consistent with temporal lobe epilepsy for some time before seeking medical care.…”

Clinical Outcomes of Large (>10 mm) Unruptured Posterior Circulation Aneurysms and Their Predictors

“…When it comes to the recurrence rate of aneurysms, there was a difference between transcranial surgery and EVT in our series, with the recurrence rate of EVT being higher than that of transcranial surgery (39.5% vs 11.1%, p=0.03). Tsianaka et al 12) also reported a high recurrence rate for EVT in posterior circulation aneurysms. In our experience, when it comes to the durability of treatment, transcranial surgery is better than EVT in large unruptured posterior circulation aneurysms.…”

“…There has been relentless debate over the superiority of transcranial surgery or EVT for intracranial aneurysm. In a recent meta-analysis, Tsianaka et al 12) reported no superiority between transcranial surgery and EVT in the treatment of posterior circulation aneurysm. However, their report lacked a subgroup analysis for large posterior circulation aneurysms 12) .…”

“…In the endovascular era, many clinicians have advocated the use of EVT to treat posterior circulation aneurysm 6,9,12) . In our series, more than 60% of patients were treated by EVT, and the complete obliteration and post-treatment complication rates of EVT were comparable to those of transcranial surgery.…”

Clipping of Posterior Circulation Intracranial Aneurysms: Maintenance of a Necessary Skill in Low-Resource Settings

“…However, mortality rates at one year did not reveal any significant differences [ 5 ]. A meta-analysis on coiling versus clipping of posterior circulation aneurysms in 2019 concluded that neither method was superior to the other in preventing permanent neurologic deficits [ 6 ]. One study assessing the clipping of 47 PICA aneurysms had no mortalities and only 2.1% morbidity (one patient) [ 7 ].…”