Medical Student Albert Einstein College of Medicine
Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is a critical condition with high risks of complications, including radiographic vasospasm, clinical vasospasm, and delayed cerebral ischemia (DCI), which impact patient outcomes. Clipping, coiling, and stenting/stent-assisted coiling are common treatment approaches. This study compares the risks of these complications across the three modalities to guide clinical decision-making.
Methods: A systematic search of four databases was conducted to identify studies comparing clipping, coiling, and stenting for aSAH. Radiographic vasospasm was defined as arterial narrowing on imaging, clinical vasospasm as neurological deficits due to ischemia, and DCI as sustained neurological deficits without other causes. A meta-analysis was performed, calculating risk ratios (RR) to compare treatment outcomes.
Results: We included 98 studies with a total of 22,027 patients: 8,654 in the clipping group, 12,216 in the coiling group, and 1,157 in the stenting group. Clinical vasospasm occurred in 36% of patients in the clipping group, 35% in the coiling group, and 34% in the stenting group. Radiographic vasospasm was observed in 49% of the clipping group, compared to 34% in both the coiling and stenting groups. DCI occurred in 26% of clipping cases, 18% in coiling, and 17% in stenting. Clipping was associated with a higher risk of clinical vasospasm (RR: 1.31, p = 0.0095) and DCI compared to coiling. No significant difference in DCI was observed between coiling and stenting (RR: 1.21, p = 0.58).
Conclusion : Clipping is associated with a significantly higher risk of clinical vasospasm compared to coiling in the management of aneurysmal SAH. These findings underscore the importance of weighing the complication risks inherent to each treatment modality for decision-making. Further research is warranted to optimize treatment strategies and improve patient outcomes.
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