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Research ArticleNeurointervention

Coil Embolization versus Clipping for Ruptured Intracranial Aneurysms: A Meta-Analysis of Prospective Controlled Published Studies

G. Lanzino, M.H. Murad, P.I. d'Urso and A.A. Rabinstein
American Journal of Neuroradiology September 2013, 34 (9) 1764-1768; DOI: https://doi.org/10.3174/ajnr.A3515
G. Lanzino
aFrom the Department of Neurosurgery (G.L.)
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M.H. Murad
bDepartment of Preventive Medicine (M.H.M.)
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P.I. d'Urso
dDepartment of Neurosurgery (P.I.d'U.), King's College Hospital, London, United Kingdom.
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A.A. Rabinstein
cDepartment of Neurology (A.A.R.), Mayo Clinic, Rochester, Minnesota
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    Fig 1.

    Meta-analysis of death and rate of poor functional outcome at 1 year.

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    Fig 2.

    Meta-analysis of rebleeding from the treated aneurysm during the first month after treatment.

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    Table 1:

    Summary of published randomized clinical trials of surgery versus coiling for ruptured aneurysms

    KuopioISATBRAT
    PeriodFebruary 1995 to August 19971997 to September 2002March 2003 to January 2007
    Single-center/multicenterSingleMulticenterSingle
    Enrollment<72 hours<28 days<14 days
    Total patients screened2429559725
    Patients enrolled1092143471
    Mean age (years)
        Endovascular495254
        Surgery505253
    No. of patients allocated endovascular521073233
    No. of patients allocated surgery571070238
    Good grade, n (% of total)93 (85.3)2018 (94.2)380 (80.7)
    Poor grade, n (% of total)16 (13.7)94 (5.8)91 (19.3)
    Crossovers
        From endovascular to surgery12975
        From surgery to endovascular4384
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    Table 2:

    Clinical outcome at 1 year (intent-to-treat analysis)

    KuopioISATBRAT
    Outcome assessment 1 yearSingle neurosurgeonPostal questionnaire filled out by patientsResearch nurse
    Definition poor outcomeGOSmRS 3–6mRS 3–6
    Poor outcome
        Endovascular12/52 (23%)250/1063 (23.5%)46/198 (23%)
        Surgery19/57 (33%)326/1055 (30.9%)69/205 (34%)
    Death
        Endovascular7/52 (13%)85/1063 (8.0%)NA
        Surgery9/57 (16%)105/1055 (9.9%)NA
    Rebleeding
        Endovascular
            Day 1–301201a
            Day 31–365060
            >1 year0100
        Surgery
            Day 1–30061
            Day 31–365040
            >1 year03a0
    One-year follow-up complete
        Endovascular100%b1063/1073 (99%)198/233 (85%)
        Surgery1055/1070 (98.6%)205/238 (86%)
    • Note:—mRS indicates modified Rankin scale; NA, not available.

    • ↵a Intent-to-treat analysis;

    • ↵b 2 patients excluded after random assignment.

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American Journal of Neuroradiology: 34 (9)
American Journal of Neuroradiology
Vol. 34, Issue 9
1 Sep 2013
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Cite this article
G. Lanzino, M.H. Murad, P.I. d'Urso, A.A. Rabinstein
Coil Embolization versus Clipping for Ruptured Intracranial Aneurysms: A Meta-Analysis of Prospective Controlled Published Studies
American Journal of Neuroradiology Sep 2013, 34 (9) 1764-1768; DOI: 10.3174/ajnr.A3515

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Coil Embolization versus Clipping for Ruptured Intracranial Aneurysms: A Meta-Analysis of Prospective Controlled Published Studies
G. Lanzino, M.H. Murad, P.I. d'Urso, A.A. Rabinstein
American Journal of Neuroradiology Sep 2013, 34 (9) 1764-1768; DOI: 10.3174/ajnr.A3515
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  • Patient Outcomes and Cerebral Infarction after Ruptured Anterior Communicating Artery Aneurysm Treatment
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    American Journal of Neuroradiology 2017 38 11
  • Time Trends in Outcomes After Aneurysmal Subarachnoid Hemorrhage Over the Past 30 Years
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    Mayo Clinic Proceedings 2018 93 12
  • Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies
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    Neurosurgical Review 2022 45 2
  • Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling—improved image quality by iterative metal artifact reduction
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  • In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis
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  • Inflammation and Human Cerebral Aneurysms: Current and Future Treatment Prospects
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