Comparison of the Safety and Efficacy between Endovascular Coiling and Surgical Clipping of Posterior Communicating Artery Aneurysms: A 10-year Retrospective Analysis of 851 Aneurysms.

Endovascular treatment is widely used for intracranial aneurysms, but evidence comparing endovascular treatment with surgical treatment for posterior communicating artery aneurysms is limited. Using a multicenter registry from January 2013 to December 2022, 841 patients with 851 posterior communicating artery aneurysms were analyzed. Logistic regression with multivariable adjustment and inverse probability of treatment weighting was applied to adjust for confounders. Of the aneurysms, 499 (58.6%) were treated by endovascular treatment. Patients undergoing endovascular treatment were generally older, had more comorbidities, and had larger aneurysms than those receiving surgical treatment. Functional outcomes assessed by the modified Rankin Scale showed no significant difference between endovascular treatment and surgical treatment in ruptured aneurysms (poor outcome at discharge: odds ratio, 1.09 [0.74-1.69]; p = 0.698; at final follow-up: odds ratio, 0.74 [0.48-1.15]; p = 0.183), whereas endovascular treatment was associated with significantly better outcomes in unruptured aneurysms (poor outcome at discharge: odds ratio, 0.11 [0.03-0.32]; p < 0.001; at final follow-up: odds ratio, 0.33 [0.11-0.96]; p = 0.045). Intraoperative and postoperative complications were similar overall (interoperative: odds ratio, 0.92 [0.55-1.54]; p = 0.752; postoperative: odds ratio, 0.76 [0.54-1.07]; p = 0.121). Subgroup analyses demonstrated that endovascular treatment reduced intraoperative complications in elderly patients, with a significant interaction between endovascular treatment and elderly age (p = 0.008). Endovascular treatment was associated with markedly higher recurrence (odds ratio, 37.41 [16.63-107.15]; p < 0.001) and retreatment rates (odds ratio, 13.73 [6.32-36.06]; p < 0.001). These findings suggest surgical treatment remains a viable option for ruptured aneurysms, providing similar functional outcomes with lower recurrence and retreatment rates, whereas endovascular treatment is suitable for unruptured aneurysms, offering comparable safety and potential advantages in elderly patients.