Outcomes of treatment modalities for ruptured intracranial aneurysms based on age - A meta-analysis

J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105039. doi: 10.1016/j.jstrokecerebrovasdis.2020.105039. Epub 2020 Jun 24.


Background: Data comparing the effect of age on outcomes of patients who underwent either endovascular coiling (EVC) or neurosurgical clipping (NSC) for ruptured intracranial aneurysms remains limited.

Objective: To better elucidate the preferred intervention for ruptured aneurysm management by presenting the results of our systematic review of the literature that evaluated the potential advantages of the two interventions between different age groups.

Methods: Systematic review of PubMed and Embase was performed (2002 - June 10, 2019) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2013 guidelines. Median ages of EVC and NSC cohorts were 54 and 56, respectively. Ages below the median were used in our "younger" cohort; ages above the median were used in our "older" cohort.

Results: We reviewed 13 studies on 7,137 patients. In the younger cohort, there were 2840 (EVC: 1412, NSC: 1428) patients. In the older cohort, there were 4297 (EVC: 2552, NSC: 1745) patients. Overall, there was a significant difference in functionality between EVC (77.70%) and NSC (69.23%) (OR=1.69; 95% C.I.: 1.10-2.60, p = 0.0212). In our younger cohort, functionality was significantly different between EVC (77%) and NSC (69%) (OR=1.54; 95% C.I.: 1.29-1.84, p < 0.001). For the older cohort, there was no significant difference in functionality, complications, or efficacy.

Conclusions: We have highlighted the importance of considering age prior to deciding which intervention is most appropriate for ruptured aneurysms, with higher morbidity and mortality with NSC versus EVC in the younger population.

Keywords: Aneurysm; Clipping; Coiling; Endovascular; Intracranial; Ruptured.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Age Factors
  • Aged
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / mortality
  • Aneurysm, Ruptured / physiopathology
  • Aneurysm, Ruptured / therapy*
  • Clinical Decision-Making
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / instrumentation
  • Endovascular Procedures* / mortality
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Neurosurgical Procedures* / adverse effects
  • Neurosurgical Procedures* / instrumentation
  • Neurosurgical Procedures* / mortality
  • Recovery of Function
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome