Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral XXXX : A Systematic Review and Meta-Analysis.

@entity432 @entity1 @entity439 @entity438
INTRODUCTION: @entity438 ( @entity438 ) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these two methods. METHODS: Literature was reviewed for all studies reporting @entity432 and/or functional outcomes in adults with unruptured @entity438 treated by endovascular coiling or microsurgical clipping. All studies that reported results for adults (>=  18 years) with unruptured @entity438 , from 1990-2011 in English were considered for inclusion. RESULTS: Twenty-six studies involving 2295 @entity439 undergoing clipping or coiling for @entity439 were included for analysis. There were 1530 @entity439 which were treated with clipping, and 765 @entity439 treated with coiling. Pooled analysis revealed failure of @entity439 in 3.0% (1.2-7.4% 95% CI) of clipped cases. Pooled analysis of 15 studies (606 @entity439 ) involving coiling and occlusion revealed lack of occlusion rates of 47.7% (43.6-51.8% 95% CI) with the fixed-effects model and 48.2% (39.0-57.4% 95% CI) with the random-effects model. Thirteen studies examined neurological outcomes after clipping and were pooled for analysis. Both fixed- and random-effect models revealed unfavourable outcomes in 2.1% (1.3-3.3% 95% CI) of @entity1 . There were 17 studies evaluating potential unfavourable neurological outcomes after coiling that were pooled for analysis. Fixed- and random-effect models revealed unfavourable outcomes in 6.5% (4.5-9.3% 95% CI) and 4.9% (3.0-8.1% 95% CI) of @entity1 respectively. CONCLUSIONS: Based upon this systematic review and meta-analysis of unruptured @entity438 , after careful consideration of @entity1 , aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured @entity438 .
