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Jaber M, Khalid H, Ansari S, Banafa A, Elagib H, Ekvtimishvili E. Microsurgical Clipping versus Endovascular Coiling in Ruptured and Unruptured Anterior Circulation Aneurysms: A Literature Review. Neuroscience Updates 2025; 3 (1) :21-35
URL: http://neuroupdates.de/article-1-124-en.html
Microsurgical Clipping versus Endovascular Coiling in Ruptured and Unruptured Anterior Circulation Aneurysms: A Literature Review
Marwan Jaber *1 , Hassan Khalid2 , Sarah Ansari1 , Ali Banafa1 , Haneen Elagib3 , Erekle Ekvtimishvili4
1- School of Health Sciences, University of Georgia, Tbilisi, Georgia
2- Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia
3- Faculty of Medicine, Georgian American University, Tbilisi, Georgia
4- Endovascular Neurosurgery Department, High Technology Medical Center, University Clinic, Tbilisi, Georgia
Abstract:   (94 Views)

Anterior circulation aneurysms are abnormal dilations of the vessel wall of the anterior circulation. Rupture can result in subarachnoid hemorrhage, cerebral infarction, hydrocephalus, motor and cognitive impairment. Microsurgical clipping (MC) is a traditional treatment modality, particularly for patients with complex neck morphology. Endovascular coiling (EC), the newer approach, offers less invasiveness with shorter recovery time. PubMed and Google Scholar were searched for articles that compare between MC and EC, using keywords such as “microsurgical clipping”, “endovascular coiling”, and “anterior circulation aneurysms”. Analysis was done from 23 studies, focusing on different anatomical subgroups and different outcomes. Out of the 23 studies, MC showed superior angiographic durability across all anterior circulation subgroups, achieving higher immediate complete occlusion rates from 78.9% to 96.4%, compared to EC (18.8% to 44.4%), which translates to a higher risk of aneurysm regrowth and necessitated retreatment for EC (13.2% in u-AC vs 1.4%). EC for unruptured lesions also carried a higher risk of asymptomatic thromboembolic events (24.5 vs 2%). Advanced endovascular strategies, such as flow diversion and web devices, which are designed to improve durability and safety, are not represented in this study. The choice between MC and EC must balance the long-term durability advantage of clipping against the lower immediate risk of neurocognitive-critical ischemic injury offered by coiling in certain locations. The choice of strategy should remain individualized, and future research should focus on more dedicated randomized clinical trials, and compare modern endovascular modalities against MC.

Keywords: Aneurysm, Anterior circulation, Microsurgery, Endovascular treatment, Middle cerebral artery, Ruptured and unruptured aneurysms
     
Type of Study: Review Article | Subject: Clinical Neuroscience
Received: 2025/03/10 | Accepted: 2025/05/15 | Published: 2025/05/20
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