How does endovascular coiling compare with neurosurgical clipping for people with aneurysmal subarachnoid hemorrhage (SAH)?

Abstract

Among adolescents and adults with aneurysmal subarachnoid hemorrhage (SAH) within the prior 28 days and mostly World Federation of Neurological Surgeons (WFNS) grade I or II severity, fewer people died or became dependent when treated with endovascular coiling than with neurosurgical clipping at two to three months (264 vs 369 per 1000 people; all values on average) through to 10 years (347 vs 431 per 1000 people); certainty of the evidence decreased over time from moderate to low. Moderate‐certainty evidence shows that fewer people developed delayed cerebral ischemia at two to three months (223 vs 265 per 1000 people) and mortality was lower at one year (79 vs 100 per 1000 people) with endovascular coiling. In contrast, more people had non‐complete obliteration after one year (336 vs 167 per 1000 people), and more people experienced post‐procedure rebleeding at one year (19 vs 10 per 1000 people; high‐certainty evidence) through to 10 years (61 vs 23 per 1000 people; low‐certainty evidence) with endovascular coiling than with neurosurgical clipping, although rebleeding rates were low in both groups. Complication rates were similar for the two surgical techniques. No trial reported on quality of life.