Background: Surgical clipping (SC) and endovascular coiling (EC) are established interventions for patients with unruptured intracranial aneurysms (UIA). However, there is still uncertainty about the optimal choice for the elderly population, due to the trade-off between procedural complications and greater occlusion durability. Therefore, this study aims to evaluate the clinical outcomes of these interventions in these patients. Methods: We searched PubMed, Embase and Cochrane Central for studies comparing SC with EC in patients with 65 years or older with UIA. Primary outcomes were functional independence (modified Rankin Scale mRs ≤ 2), short (in hospital) and long-term mortality (1 year). Secondary outcomes were procedure-related bleeding, aneurysm recurrence and length of hospital stay. Statistical analysis was performed using RevMan 4.5.1. Heterogeneity was quantified with I2 statistics. Results: We included 39,510 patients from 10 studies. Of these, 13,984 (35.4%) underwent SC and 25,526 (64.6%) underwent EC. The mean age was 70.5 ± 3.9 years in the SC groupand 72.3 ± 5.2 years in the EC group. The analysis revealed that the SC group had a significantly higher risk for bleeding (RR: 4.01; 95% CI: 3.17-5.06; p<0.00001; I2=0%) and in-hospital mortality (RR: 2.24; 95% CI: 1.72-2.91; p<0.00001; I2=0%) compared to the EC group. Additionally, the length of hospital stay was significantly longer for the SC group (MD: 4.11 days; 95% CI: 2.94-5.29; p <0.00001). However, this finding was constrained by high heterogeneity (I2=93%). Although the SC group showed a lower risk for aneurysm recurrence , it was not statistically significant (RR: 0.31; 95% CI: 0.06-1.64; p=0.17; I2=0%). There was no significant difference between both groups for mRS ≤ 2 (RR: 0.93; 95% CI: 0.81-1.06; p=0.25; I2=85%) and 1-year mortality (RR: 1.00; 95% CI: 0.71-1.41; p=0.99; I2=68%). Conclusion: In conclusion, for elderly patients with unruptured intracranial aneurysms, endovascular coiling demonstrates superior short-term safety over surgical clipping, with significantly lower risks of procedure-related bleeding and in-hospital mortality. It is generally the preferred intervention for optimizing immediate safety in this population, while clipping may be reserved for select cases prioritizing anatomical durability when acute risks are acceptable.
Lima et al. (Thu,) studied this question.