Intracranial aneurysms (IAs) affect 1–2% of the population, with an annual rupture rate of approximately 1%, leading to significant morbidity and mortality. Most aneurysms remain asymptomatic throughout life, but rupture can result in subarachnoid hemorrhage (SAH), which carries a mortality rate of up to 40% and long-term disability in over 30% of survivors. Risk factors influencing rupture include size, morphology, location, and patient demographics. Current treatment modalities—microsurgical clipping and endovascular coiling—are chosen based on anatomical and patient-specific factors. A systematic search of three databases identified 1290 articles, from which 68 studies were selected for full-text review. Twenty-one studies met the inclusion criteria and were analyzed for patient outcomes following microsurgical clipping or endovascular coiling. Data extracted included patient demographics, aneurysm characteristics, treatment approach, and clinical outcomes based on the modified Rankin Scale (mRS). Among the included studies, 10 evaluated ACoA aneurysms (5 clipping, 5 coiling) and 11 evaluated MCA aneurysms (4 clipping, 7 coiling). For ACoA aneurysms, microsurgical clipping in 229 patients resulted in favorable outcomes (mRS 0–1) in 95% of cases, with a 4% morbidity rate. Endovascular coiling in 380 patients yielded a 99% favorable outcome rate with 1% morbidity. For MCA aneurysms, clipping demonstrated higher rates of definitive aneurysm occlusion with minimal recurrence, whereas endovascular coiling exhibited a 10% minor recurrence rate and a 5–6% major recurrence rate requiring retreatment. Technological advancements in endovascular techniques have improved feasibility and safety for MCA aneurysms, but clipping remains the preferred approach for complex cases due to anatomical considerations. Both microsurgical clipping and endovascular coiling are effective treatments for aneurysms of the anterior circulation, with high rates of favorable clinical outcomes. Endovascular coiling demonstrated lower morbidity but higher recurrence rates, whereas clipping provided more durable aneurysm obliteration. Treatment decisions should be tailored based on aneurysm morphology, patient-specific factors, and institutional expertise.
Al-Jehani et al. (2025) studied this question.