• Alexander F C Hulsbergen, Lida Mirzaei, Arthur T J van der Boog, Timothy R Smith, Ivo S Muskens, Broekman Marike L D MLD Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Harvard Medical School, Boston, Massa, Rania A Mekary, and Wouter A Moojen.
• Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands; Department of Neurosurgery, Haga Teaching Hospital, The Hague, Zuid-Holland, the Netherlands; Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands.
• World Neurosurg. 2019 Dec 1; 132: e820-e833.

ObjectiveThe long-term durability of different modalities of intracranial aneurysm repair remains unclear. The aim of this study was to conduct a meta-analysis comparing long-term rates of intracranial aneurysm recurrence, retreatment, and rebleeding after surgical clipping or endovascular treatment (EVT).MethodsA systematic review of PubMed and Embase was performed in accordance with the PRISMA guidelines and a meta-analysis was conducted. Cohort studies and randomized controlled trials (RCTs) with a surgical and an endovascular arm of ≥10 patients each and a median follow-up of ≥3 years were included. Pooled-effect estimates for reported outcomes were calculated using the random-effects model; sensitivity analysis was performed using the fixed-effects model.ResultsOf 4876 articles, 11 studies including 3 RCTs comprising 4517 patients were analyzed. Coiling was the modality of EVT in all included studies. In the random-effects model, coiling was associated with an increased relative risk of 8.1 for recurrence (95% confidence interval [CI], 3.8-17.2), 4.5 for retreatment (95% CI, 3.4-5.9), and 2.1 for rebleeding (95% CI, 1.3-3.5); the fixed-effects model yielded similar results. Meta-regression by study design, length of follow-up, age, aneurysm size, ruptured versus unruptured aneurysms, or posterior versus anterior location did not yield significant results (all P interactions >0.05). No significant publication bias was identified.ConclusionsThese results indicate better long-term durability of clipping compared with coiling-based EVT. The relatively high incidence of recurrence and retreatment after coiling should be considered when determining treatment strategy.Copyright © 2019 Elsevier Inc. All rights reserved.

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