Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage

Endovascular coiling of ruptured aneurysms in the brain leads to a better outcome than surgical clipping. Bleeding on the surface of the brain is called a subarachnoid haemorrhage. The bleeding usually comes from the rupture of a weak spot in an artery carrying blood to the brain. This weak spot is like a small balloon, or blister, which is called an aneurysm. The outcome after subarachnoid haemorrhage is generally poor: half the patients die within one month; and of those who survive the initial month, just under half remain dependent on someone else for help with activities of daily living such as walking, dressing, and bathing. One of the risks in patients with subarachnoid haemorrhage is rebleeding. There are two main ways to try to stop this: operative clipping of the neck of the aneurysm or blocking of the aneurysm from inside by endovascular coiling. This review shows that the number of people who survive and are independent in their daily living is higher after coiling than after clipping. The evidence comes mainly from one large trial.