A comparative study of the risk of delayed cerebral ischemia after clipping and coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Introduction Delayed cerebral ischemia (DCI) is one of the main causes of disability and death following surgical treatment of ruptured intracranial aneurysms. Many studies combine data from patients undergoing clipping and coiling; however, this approach may be inappropriate. The purpose of this study was to compare the incidence of DCI between the two surgical methods and to explore, separately for each method, the predictive factors of DCI. Methods This study systematically searched relevant articles on DCI after intracranial aneurysm surgery published in the PubMed, EMBASE, and Web of Science databases since their inception up to October 2025. After screening for inclusion criteria, RevMan software was used to perform a meta-analysis of the eligible studies. Results This study included a total of 21 articles, including 5,358 patients. The results showed that there was a significant difference in the incidence of DCI after clipping and coiling. The combined OR value was 1.57 (95 % CI: 1.31–1.89), and the heterogeneity was within the acceptable range. The difference was statistically significant. In patients undergoing clipping, Fisher grade (OR 2. 11; 95 % CI: 1.57–2.84) and WFNS classification (OR 1.73; 95 % CI: 1.19–2.5) was a significant predictor of DCI, and the heterogeneity was low. Gender (OR 0.98; 95 % CI: 0.53–1.80), age (OR 1.34; 95 % CI: 0.13–2.55), hypertension (OR 0.97; 95 % CI: 0.75–1.25), diabetes (OR 1.48; 95 % CI: 0.77–2.83) and smoking history (OR 0.78; 95 % CI: 0.54–1.11) showed no statistical significance. In patients with interventional embolization, age (OR 3.34; 95 % CI: 1.27–5.41) and Fisher grade (OR 3.86; 95 % CI: 2.04–7.31) had a significant predictive effect on the occurrence of DCI. Conclusion This study suggests that patients who have undergone clipping have a higher risk of DCI compared with patients undergoing coiling. Certain risk factors have shown a stronger predictive value in patients undergoing coiling. These conclusions require further validation by additional high quality studies.