Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage

Irene van der Schaaf; Ale Algra; Marieke Wermer; Andrew Molyneux; Mike J Clarke; Jan van Gijn; Gabriel JE Rinkel

doi:10.1002/14651858.CD003085.pub2

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Analysis 1.1

Comparison 1 Poor outcome, Outcome 1 death or dependency at 2 to 3 months.

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Analysis 1.2

Comparison 1 Poor outcome, Outcome 2 death or dependency at 12 months after SAH.

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Analysis 1.3

Comparison 1 Poor outcome, Outcome 3 worst‐case scenario at 12 months.

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Analysis 2.1

Comparison 2 Secondary cerebral ischaemia, Outcome 1 2 to 3 months.

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Analysis 3.1

Comparison 3 Recurrent haemorrhage, Outcome 1 rebleed before treatment.

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Analysis 3.2

Comparison 3 Recurrent haemorrhage, Outcome 2 rebleed post‐procedure up to 1 year.

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Analysis 3.3

Comparison 3 Recurrent haemorrhage, Outcome 3 rebleed post‐procedure up to 3 months.

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Analysis 4.1

Comparison 4 Case fatality, Outcome 1 death from any cause 2 to 3 months.

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Analysis 4.2

Comparison 4 Case fatality, Outcome 2 death from any cause between randomisation and 1 year after SAH.

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Analysis 5.1

Comparison 5 Complications from intervention, Outcome 1 complications from intervention.

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Analysis 6.1

Comparison 6 Degree of obliteration, Outcome 1 non‐complete obliteration after 1 year.

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Analysis 6.2

Comparison 6 Degree of obliteration, Outcome 2 less than 90% occlusion after 1 year.

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Analysis 7.1

Comparison 7 Subgroup analysis: aneurysm location, Outcome 1 12 month poor outcome posterior and anterior circulation.

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Comparison 1. Poor outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 death or dependency at 2 to 3 months Show forest plot	3	2257	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.63, 0.81]

2 death or dependency at 12 months after SAH Show forest plot	3	2243	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.67, 0.88]

3 worst‐case scenario at 12 months Show forest plot	3	2272	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.70, 0.92]

Comparison 1. Poor outcome

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Comparison 2. Secondary cerebral ischaemia

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 2 to 3 months Show forest plot	2	129	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.68, 1.41]

Comparison 2. Secondary cerebral ischaemia

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Comparison 3. Recurrent haemorrhage

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 rebleed before treatment Show forest plot	3	2272	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.37, 1.12]

2 rebleed post‐procedure up to 1 year Show forest plot	3	2272	Risk Ratio (M‐H, Fixed, 95% CI)	2.00 [1.08, 3.70]

3 rebleed post‐procedure up to 3 months Show forest plot	3	2272	Risk Ratio (M‐H, Fixed, 95% CI)	2.66 [0.71, 10.00]

Comparison 3. Recurrent haemorrhage

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Comparison 4. Case fatality

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 death from any cause 2 to 3 months Show forest plot	3	2257	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.66, 1.18]

2 death from any cause between randomisation and 1 year after SAH Show forest plot	3	2243	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.63, 1.05]

Comparison 4. Case fatality

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Comparison 5. Complications from intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 complications from intervention Show forest plot	2	129	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.44, 2.53]

Comparison 5. Complications from intervention

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Comparison 6. Degree of obliteration

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 non‐complete obliteration after 1 year Show forest plot	2	1038	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [1.29, 2.17]

2 less than 90% occlusion after 1 year Show forest plot	2	1038	Risk Ratio (M‐H, Fixed, 95% CI)	1.73 [0.97, 3.09]

Comparison 6. Degree of obliteration

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Comparison 7. Subgroup analysis: aneurysm location

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 12 month poor outcome posterior and anterior circulation Show forest plot	2	2226	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.66, 0.88]

1.1 12 month poor outcome posterior circulation	2	69	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.19, 0.92]
1.2 12 month poor outcome anterior circulation	2	2157	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.68, 0.90]

Comparison 7. Subgroup analysis: aneurysm location

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