1384 Endovascular Treatment Versus Neurosurgical Clipping in the Management of Unruptured Intracranial Aneurysms: An Updated Systematic Review and Meta-Analysis

INTRODUCTION: The emergence of high-resolution brain imaging technologies has enabled early identification of Unruptured Intracranial Aneurysms (UIAs). UIAs can evolve into subarachnoid hemorrhage (SAH), and prophylaxis of complications includes neurosurgical clipping and endovascular treatment, yet the optimal treatment choice remains incompletely understood. METHODS: PubMed, Embase, and Cochrane were searched for randomized clinical trials and observational studies comparing endovascular treatment with surgical clipping for the management of unruptured intracranial aneurysms and reporting outcomes of (1) risk of death; (2) risk of complete occlusion; and (3) risk of intracranial bleeding. Heterogeneity was assessed using I 2 statistics. A random-effects model was used for outcomes with high heterogeneity. RESULTS: 18 studies totaling 12,300 patients were included. The relative risk of death was 0.63 (95% CI 0.27-1.51; p=0.302; I 2 =0%) for the group receiving ET compared to those receiving SC. The relative risk of complete aneurysm occlusion was 0.82 (95% CI 0.67-1.01; p=0.06; I 2 =86%), and the relative risk of intracranial bleeding was 0.52 (95% CI 0.25-1.07; p=0.075; I 2 =53%) for the same respective groups. There was no statistical significance in any of the results. CONCLUSIONS: Comparing ET and SC, the choice of treatment for UIAs should be individualized given the similarity in efficacy of both management modalities in the reported primary outcomes.