Neuroradiology · 2026
Endovascular treatment versus microsurgical clipping in elderly patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Brown George, Sivanesan Danesh, Kannan Siddarth, Gillespie Conor, Siow Isabel, Fairhead Rory, Mancuso-Marcello Marco, Bhogal Paul, Dinesh Nivedh, Nagarjun Bolem, Low Shiong Wen, Sun Ira, Lim Jia Xu, Gopinathan Anil, Kee Tze Phei, Lee Wickly, Keong Nicole, Cheong Tien Meng, Yeo Tseng Tsai, Nga Vincent Diong Weng, Han Julian, Kirollos Ramez, Lee Keng Siang
Аннотация
BACKGROUND: The optimal treatment strategy for elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. While endovascular coiling and surgical clipping are both established interventions, age-related physiological vulnerability and comorbidity burden may alter the risk-benefit profile. We performed a systematic review and meta-analysis to compare outcomes between these two modalities in elderly patients with aSAH.
METHODS: Searches of PubMed, Embase, Scopus, and Cochrane CENTRAL were conducted from inception to 20th July 2025. The definition of elderly patients aged ≥ 60 years was adopted as per the World Health Organization. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0-2) and mortality. Secondary outcomes were delayed cerebral ischemia (DCI), delayed hydrocephalus and rebleed.
RESULTS: Twenty studies (2 randomized controlled trials, 18 observational) were included. A total of 44,526 patients were included with 24,724 aneurysms clipped and 19,802 coiled. The mean age was 72.1 years in the coiling cohort and 72.8 years in the clipping cohort. Aneurysm location was anterior in 94% of cases. Hypertension was more prevalent in the coiling cohort (OR 1.25, 95% CI 1.03-1.51; p = 0.024). There was no association between poor-grade WFNS score 4-5 and treatment modality (OR = 0.89, 95% CI: 0.62-1.27; p = 0.471). There was no significant difference between coiling and clipping in achieving favorable outcomes (OR 1.07, 95% CI 0.75-1.52; p = 0.712) or mortality (OR 0.89, 95% CI 0.64-1.23; p = 0.471). Rates of delayed cerebral ischemia, hydrocephalus, and rebleeding were also comparable.
CONCLUSIONS: Current evidence, derived from mainly observational studies, does not suggest difference in functional outcomes nor mortality between endovascular coiling and surgical clipping in elderly patients with aSAH. However, significant selection bias, variability in age definitions and the lack of randomized comparisons should be considered when interpreting these findings.
METHODS: Searches of PubMed, Embase, Scopus, and Cochrane CENTRAL were conducted from inception to 20th July 2025. The definition of elderly patients aged ≥ 60 years was adopted as per the World Health Organization. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0-2) and mortality. Secondary outcomes were delayed cerebral ischemia (DCI), delayed hydrocephalus and rebleed.
RESULTS: Twenty studies (2 randomized controlled trials, 18 observational) were included. A total of 44,526 patients were included with 24,724 aneurysms clipped and 19,802 coiled. The mean age was 72.1 years in the coiling cohort and 72.8 years in the clipping cohort. Aneurysm location was anterior in 94% of cases. Hypertension was more prevalent in the coiling cohort (OR 1.25, 95% CI 1.03-1.51; p = 0.024). There was no association between poor-grade WFNS score 4-5 and treatment modality (OR = 0.89, 95% CI: 0.62-1.27; p = 0.471). There was no significant difference between coiling and clipping in achieving favorable outcomes (OR 1.07, 95% CI 0.75-1.52; p = 0.712) or mortality (OR 0.89, 95% CI 0.64-1.23; p = 0.471). Rates of delayed cerebral ischemia, hydrocephalus, and rebleeding were also comparable.
CONCLUSIONS: Current evidence, derived from mainly observational studies, does not suggest difference in functional outcomes nor mortality between endovascular coiling and surgical clipping in elderly patients with aSAH. However, significant selection bias, variability in age definitions and the lack of randomized comparisons should be considered when interpreting these findings.