Comparative Outcomes of Endovascular Coiling versus Microsurgical Clipping in the Treatment of Ruptured Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis

Abstract Ruptured anterior communicating artery (AComA) aneurysms are a major cause of aneurysmal subarachnoid hemorrhage, and the optimal treatment—microsurgical clipping or endovascular coiling—remains debated. A systematic review and meta-analysis (PROSPERO CRD420251176980) compared outcomes of clipping versus coiling in adults with ruptured AComA aneurysms. Ten retrospective cohort studies involving 1,450 patients were included. Pooled analyses used random-effects models, and risk of bias was assessed with ROBINS-I. There were no significant differences between clipping and coiling in favorable discharge outcomes (Glasgow Outcome Scale ≥4), mortality, or major procedural complications. Hospital length of stay was significantly shorter with coiling. Overall heterogeneity was low to moderate, except for length of stay. Microsurgical clipping and endovascular coiling yield comparable functional and safety outcomes in ruptured AComA aneurysms, while coiling may reduce hospitalization duration. Prospective controlled studies are required to optimize individualized treatment selection.