title: Coiling Is Not Superior to Clipping in Patients with High-Grade Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Outcomes of coiling embolization versus clipping for patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) have not been previously compared. We reviewed current evidence regarding the safety and efficacy of clipping versus coiling for high-grade aSAH.
  
  
  METHODS
  We conducted a meta-analysis of studies that compared clipping with coiling in patients with high-grade aSAH published from January 1999 to February 2016 in Medline, Embase, and Cochrane databases based on PRISMA inclusion and exclusion criteria. Binary outcome comparisons between clipping and coiling were described using odds ratios (ORs).
  
  
  RESULTS
  Three randomized controlled trials (RCTs) and 16 observational studies were included. There was no statistical difference in good outcome rates between the clipping and coiling groups (OR, 1.44; 95% confidence interval [CI], 0.97-2.13). Subgroup analysis showed no significant difference between the 2 treatments in non-RCTs (OR, 1.49; 95% CI, 0.95-2.36) and RCTs (OR, 1.15; 95% CI, 0.59-2.25). Coiling was associated with higher mortality (OR, 0.55; 95% CI, 0.41-0.75). Lower mortality was associated with clipping in non-RCTs (OR, 0.54; 95% CI, 0.40-0.74), but there was no difference in the RCTs (OR, 0.79; 95% CI, 0.19-3.39). Coiling was not associated with lower rates of complications including rebleeding (OR, 0.62; 95% CI, 0.30-1.29), ischemic infarct (OR, 0.89; 95% CI, 0.53-1.49), symptomatic vasospasm (OR, 0.76; 95% CI, 0.45-1.29), or shunt-dependent hydrocephalus (OR, 1.33; 95% CI, 0.52-3.40).
  
  
  CONCLUSIONS
  The outcome with coiling is not superior to clipping in patients with high-grade aSAH; moreover, coiling has a greater risk of mortality.
authors.affiliation: Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Xia
authors.affiliation: Department of Gastroenterology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Jun-Yu
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Hunan Province Brain Hospital, Changsha, Hunan, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Feng-Hua
authors.initials: FH
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Qi-Zhuang
authors.initials: QZ
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Shuang-Shi
authors.initials: SS
authors.lastname: Fan
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Zi-Gui
authors.initials: ZG
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: claychengquan@126.com.
authors.forename: Quan
authors.initials: Q
authors.lastname: Cheng
mesh_terms: D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic / Q000295:instrumentation / Q000379:methods / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards; D016896:Treatment Outcome
keywords: Clipping; Coiling; High-grade aSAH; Meta-analysis; Ruptured intracranial aneurysms; Systematic review