Comparative outcomes of coil embolization and surgical clipping in elderly patients with subarachnoid hemorrhage: a systematic review and meta-analysis
Abstract
Elderly patients with subarachnoid hemorrhage (SAH) face a disproportionately high burden of morbidity and mortality. While endovascular coiling is often favored in this population, direct comparisons with surgical clipping are limited. We conducted a meta-analysis to compare outcomes of clipping versus coiling in SAH patients aged ≥ 60 years. A systematic search of PubMed, Embase, and Cochrane databases identified studies comparing the two treatments in this age group. The primary outcome was a composite of unfavorable outcomes (modified Rankin Scale [mRS] > 2 and mortality). Secondary outcomes included mortality, favorable outcome (mRS 0–2), rebleeding, and hospital length of stay. Heterogeneity was assessed using I² statistics, with subgroup analysis by age decade. Twenty-seven studies (2 randomized controlled trials [RCTs]) involving 51,415 patients (59.6% treated with clipping) were included. There were no significant differences between clipping and coiling for unfavorable outcome (RR 1.03; 95% CI 0.96–1.11), favorable outcome (RR 1.02; 95% CI 0.93–1.11), mortality (RR 1.08; 95% CI 0.97–1.19), or rebleeding (RR 1.21; 95% CI 0.57–2.57). However, coiling was associated with shorter hospital stays (MD -2.53 days; 95% CI -4.58 to -0.49; p = 0.0152). RCTs showed a non-significant trend favoring coiling, while observational studies leaned toward clipping. Heterogeneity for main outcomes was moderate (I² = 57.7%). Using the GRADE framework, overall certainty of evidence was…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 51,415 participants or records.
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