A Meta-analysis Comparing The Incidence Of Vasospasm And Clinical Outcome Between Early Surgical Clipping And Endovascular Coiling Of Ruptured Intracranial Aneurysm

Objective: Cerebral vasospasm is one of the most important complications that cause death and disability. The amount of blood in the subarachnoid space was thought to be the most important predictors of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Early surgical blood removal of subarachnoid space has been shown to reduce the incidence of cerebral vasospasm. In contrast with surgical clipping, endovascular coiling does not involve intra-operative removal of blood clots from the subarachnoid space. In theory, the incidence of vasospasm in patients receiving endovascular coiling may be higher than in patients treated by surgical clipping, but in fact there is still a debate on the impact of different treatment modalities of ruptured aneurysm on cerebral vasospasm. The objective of this meta-analysis was to evaluate the influence of different modalities in early treatment of aneurysmal subarachnoid hemorrhage on the incidence of vasospasm and clinical outcome. Methods: Literature search in Pubmed and CNKI was conducted, using the English keywords"subarachnoid hemorrhage""intracranial aneurysm""cerebral vasospasm""clipping""coiling"and parallel Chinese keywords. Studies in which"cerebral vasospasm"presented as one of the outcome measures were collected and then screened by the eligibility criteria. Data extracted from the eligible studies were analyzed by the software ReviewManager5.0.Results: Five studies fulfilled the eligibility criteria, all of them were English. When data from different studies were pooled together, the overall results showed that the patients of aneurysmal subarachnoid hemorrhage treated with early endovascular coiling had a significant lower incidence of symptomatic cerebral vasospasm than that treated with early surgical clipping, the value of Risk Ratio (RR) was 0.57, 95% confident interval was 0.41-0.79, the P value was 0.0007. And the overall results showed no significant difference between clipping and coiling regarding to other outcome measures such as"cerebral infarcts and delayed ischemic neurological deficits (DIND) associated with cerebral vasospasm","mortality"and"poor outcome". Conclusion According to the available data, the incidence of symptomatic vasospasm in early endovascular coiling group is significant lower than that of early surgical clipping, and there is no significant difference between the different modalities of early aneurysm occlusion on the risk of cerebral infarcts and delayed ischemic neurological deficits associated with cerebral vasospasm, mortality and poor outcome.