Background: Neurosurgical clipping used to be the standard method of occluding intracranial aneurysms, but controlled detachable coils are increasingly used to obliterate aneurysms by endosaccular packing.
Review summary: A systematic review of observational studies on embolization with coils showed in patients with a ruptured aneurysm a complete occlusion in 52% of aneurysms, independence at follow-up in 89% of patients, and a procedure related mortality of 1.1%. There is no consensus with regard to the indications for surgical or endovascular treatment. A recently published randomized trial on early coiling versus early operation did not show any differences in clinical outcome after 3 and 12 months, but the small number of patients included precludes firm conclusions. Comparisons between endovascular and surgical treatment should not only address safety and clinical outcome, but also the long-term angiographic results and the risk of recurrent hemorrhage after treatment. In current practice, many patients with a basilar bifurcation aneurysm are treated by embolization with coils. In many patients with a middle cerebral artery aneurysm operation is the preferred treatment. For all other aneurysm locations preference for coiling or clipping depends on the clinical condition of the patient, the configuration of the aneurysm, and on the experience and skills of the local endovascular and neurosurgical team.
Conclusions: Endovascular treatment of intracranial aneurysms has gained widespread acceptance. Preference for coiling or clipping depends on patient and aneurysm characteristics, and on the local expertise.