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(Stroke. 2006;37:572.)
© 2006 American Heart Association, Inc.

Cochrane Corner

Endovascular Coiling Versus Neurosurgical Clipping for Patients With Aneurysmal Subarachnoid Hemorrhage

Irene van der Schaaf, MD; Ale Algra, MD; Marieke J. Wermer, MD; Andrew Molyneux, MD; Mike Clarke, Dphil; Jan van Gijn, MD Gabriël Rinkel, MD

From the Department of Radiology (I.vdS.), University Medical Centre, Utrecht, the Netherlands; the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Centre, Utrecht, the Netherlands; the Department of Neurology (M.J.W., J.vG., G.R.), University Medical Center, Utrecht, the Netherlands; Neurovascular Research Unit (A.M.), University of Oxford, United Kingdom; and UK Cochrane Centre (M.C.), Oxford, UK.

Correspondence to Irene C. van der Schaaf, Department of Radiology E01.132, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail i.vanderschaaf@rrr.azu.nl

Section Editor: Graeme J. Hankey MD, FRCP

Key Words: aneurysm • subarachnoid hemorrhage

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Patients who have had an aneurysmal subarachnoid hemorrhage (SAH) are at very high risk of rebleeding if the aneurysm is not treated. The standard treatment for several decades has been surgical clipping of the neck of the aneurysm. In recent years, an alternative, the introduction of detachable coils to occlude the aneurysm, has become more common.

	Objectives

 
The goal was to compare the effects of endovascular coiling versus neurosurgical clipping in patients with aneurysmal SAH.

	Methods

 
Search Strategy
We searched the Cochrane Stroke Group Trials Register (last searched in February 2005). In addition, we searched MEDLINE (1966 to January 2004) and EMBASE (1980 to January 2004) and contacted trialists.

Selection Criteria
We included randomized trials in which endovascular coiling of aneurysms was compared with neurosurgical clipping in patients with SAH who have proven aneurysm.

Data Collection and Analysis
Two authors independently extracted the data and assessed trial quality. Trialists were contacted to obtain missing information. The primary analyses were based on the intention-to-treat results of the individual trials, for "poor outcome" (death or dependence), and for case fatality.

	Results

 
We identified 3 randomized trial^1,2 (Brilstra and Lusseveld E, unpublished data, 2002). The trials included a total of 2272 patients (2143, 109, and 20 patients per trial, respectively). Most of the patients were in good clinical condition and had an aneurysm on the anterior circulation. After 1 year of follow-up, the relative risk of poor outcome for coiling versus clipping was 0.76 (95% CI, 0.67 to 0.88; Figure). The absolute risk reduction was 7% (95% CI, 4% to 11%). This means . . . [Full Text of this Article]