title: Coil embolization versus clipping for ruptured intracranial aneurysms: a meta-analysis of prospective controlled published studies.
abstract: OBJECTIVE
  Coil embolization is an alternative to clipping for intracranial aneurysms. However, controversy exists regarding the best therapeutic strategy in patients with ruptured aneurysms, and there is great center- and country-related variability in the rates of clipping versus coiling. We performed a meta-analysis of prospective controlled trials of clipping versus coil embolization for ruptured aneurysms.
  
  
  METHODS
  We performed a search of the English literature for published prospective controlled trials comparing surgical clipping with endovascular coil embolization for ruptured intracranial aneurysms. Data were abstracted from the identified references. Outcomes of interest were the proportion of patients with a poor outcome at 1 year and episodes of rebleeding from the index treated aneurysm after the allocated treatment.
  
  
  RESULTS
  There were 3 prospective controlled trials eligible for inclusion. These studies enrolled 2723 patients. Meta-analysis of these studies showed that the rate of poor outcome at 1 year was significantly lower in patients allocated to coil embolization (risk ratio, 0.75; 95% confidence interval, 0.65-0.87). This relative effect is consistent with an absolute risk reduction of 7.8% and a number needed to treat of 13. The effect on mortality was not statistically different across the 2 treatments. Rebleeding rates within the first month were higher in patients allocated to endovascular coil embolization.
  
  
  CONCLUSIONS
  On the basis of the analysis of the 3 high-quality prospective controlled trials available, there is strong evidence to indicate that endovascular coil embolization is associated with better outcomes compared with surgical clipping in patients amenable to either therapeutic strategy.
authors.affiliation: Department of Neurosurgery.
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
authors.forename: M H
authors.initials: MH
authors.lastname: Murad
authors.forename: P I
authors.initials: PI
authors.lastname: d'Urso
authors.forename: A A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D002543:Cerebral Hemorrhage / Q000401:mortality*; D015897:Comorbidity; D018849:Controlled Clinical Trials as Topic / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000401:mortality*; D019317:Evidence-Based Medicine; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality*