Supplementary Files
Keywords
anterior communicating artery aneurysms
endovascular coiling
microsurgical clipping
How to Cite
Abstract
Objective: Intracranial aneurysms are pathological enlargements of intracranial arteries that frequently manifest at the arterial branching sites. Surgical intervention of the anterior communicating artery aneurysm may present technical difficulties due to its irregular anatomical configuration, intricate hemodynamics, and unfavorable morphology that hinders successful clipping. Another method of treatment is endovascular coiling of an aneurysm. Both treatment modalities are complementary rather than competitive due to their respective strengths and limitations. This study aims to compare the two treatment modalities.
Methods: This study was conducted to get the local evidence and implement the results of this study to reduce complications and improve the outcome of surgery. So, this experimental study was done at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, for 12 months. Sample size of 60 cases; 30 cases in each group were included through Non-Probability Consecutive sampling. Group A patients were subjected to clipping-based surgery. Patients in group B underwent an endovascular procedure utilizing coiling. Patients were observed for mortality and complications during stay in hospital, and the outcome of 3 months follow up.
Results: Patients who underwent clipping had a significantly higher rate of favorable outcomes (23 out of 30; 76.7%) compared to those who underwent Coiling (7 out of 30; 23.3%).
Conclusion: Surgical clipping carries a promising treatment option for anterior communicating artery aneurysm with good long-term prognosis compared to endovascular clipping. Clipping carries a higher risk of some complications, such as surgical site infection, meningitis, and CSF leak. In contrast, endovascular coiling carries higher mortality and morbidity, with a higher rate of focal neurological deficits and poorer prognosis.
Keywords: Intracranial aneurysm, anterior communicating artery aneurysm, embolization, therapeutic, neurosurgical procedures, microsurgery.
References
Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, et al. The Barrow Ruptured Aneurysm Trial: 3-year results: Clinical article. J Neurosurg. 2013 July;119(1):146–57. https://doi.org/10.3171/2013.3.JNS12683
Mocco J, Brown RD, Torner JC, Capuano AW, Fargen KM, Raghavan ML, et al. Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis. Neurosurgery. 2018 Apr;82(4):491–6.
Kato Y, Kumar A, Chen S. Surgical nuances of clipping after coiling: Looking beyond the international subarachnoid aneurysm trial. J Clin Neurosci. 2012 May;19(5):638–42. https://doi.org/10.1016/j.jocn.2011.08.022
CG D. Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J neurosurg. 1988;68:985-6.
Jiang Z, Zhang X, Wan X, Wei M, Liu Y, Ding C, et al. Efficacy and Safety of Combined Endovascular Embolization and Stereotactic Radiosurgery for Patients with Intracranial Arteriovenous Malformations: A Systematic Review and Meta‐Analysis. Ito H, editor. BioMed Res Int. 2021 Jan;2021(1):6686167. https://doi.org/10.1155/2021/6686167
Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RSC. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). The Lancet. 2015 Feb;385(9969):691–7. https://doi.org/10.1016/S0140-6736(14)60975-2
Wójtowicz K, Czarzasta K, Przepiorka L, Kujawski S, Cudnoch-Jedrzejewska A, Marchel A, Kunert P. Brain-derived neurotrophic factor (bdnf) concentration levels in cerebrospinal fluid and plasma in patients with glioblastoma: a prospective, observational, controlled study. Cureus. 2023 Nov 3;15(11). https://doi.org/10.7759/cureus.48237
Wiebers DO, Piepgras DG, Meyer FB, Kallmes DF, Meissner I, Atkinson JLD, et al. Pathogenesis, Natural History, and Treatment of Unruptured Intracranial Aneurysms. Mayo Clin Proc. 2004 Dec;79(12):1572–83. https://doi.org/10.4065/79.12.1572
Raymond J, Roy D, Weill A, Guilbert F, Nguyen T, Molyneux AJ, et al. Unruptured intracranial aneurysms: Their illusive natural history and why subgroup statistics cannot provide normative criteria for clinical decisions or selection criteria for a randomized trial. J Neuroradiol. 2008 Oct;35(4):210–6. https://doi.org/10.1016/j.neurad.2007.12.001
Hoh BL, Ko NU, Amin-Hanjani S, Chou SH, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL. 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-70. https://doi.org/10.1161/STR.0000000000000436
Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol. 2016 Dec;12(12):699–713. https://doi.org/10.1038/nrneurol.2016.150
Lee KS, Zhang JJY, Nguyen V, Han J, Johnson JN, Kirollos R, et al. The evolution of intracranial aneurysm treatment techniques and future directions. Neurosurg Rev. 2022 Feb;45(1):1–25. https://doi.org/10.1007/s10143-021-01543-z
Al Fauzi A, Rahmatullah MI, Suroto NS, Utomo B, Fahmi A, Bajamal AH, et al. Comparison of outcomes between clipping and endovascular coiling in anterior choroidal artery aneurysm: a systematic review. Neurosurg Rev. 2023 Oct 20;46(1):276. https://doi.org/10.1007/s10143-023-02179-x
Kang X kui, Guo S fu, Lei Y, Wei W, Liu H xin, Huang L li, et al. Endovascular coiling versus surgical clipping for the treatment of unruptured cerebral aneurysms: Direct comparison of procedure-related complications. Medicine (Baltimore). 2020 Mar;99(13):e19654. https://doi.org/10.1097/MD.0000000000019654
Hamming A, Van Dijck J, Singh R, Peul W, Moojen W. Comparison of long-term clinical outcome after endovascular versus neurosurgical treatment of ruptured intracranial anterior circulation aneurysms: A single-centre experience. Brain Spine. 2024;4:102902. https://doi.org/10.1016/j.bas.2024.102902
Batista S, Ferreira MY, Brenner LBO, Semione G, Bocanegra-Becerra JE, Bertani R, et al. Surgical clipping and endovascular treatments for small or very small anterior communicating artery aneurysms: A comparative pooled analysis. J Clin Neurosci. 2024 Sept;127:110766. https://doi.org/10.1016/j.jocn.2024.110766
Liu Q, Wu S, Shao J, Liu Y, Lu Y, Wu H, et al. Metabolic syndrome parameters’ variability and stroke incidence in hypertensive patients: evidence from a functional community cohort. Cardiovasc Diabetol. 2024 June 15;23(1):203.
Ahmed H. Gohar, Ahmed M. El-Sherif, Magdy A. El-Hawary. EVALUATION OF THE RESULTS OF DIFFERENT MODALITIES OF TREATMENT OF INTRACRANIAL ANEURYSMS. Al-Azhar Med J. 2022 Aug 1;51(4):2157–68. https://doi.org/10.21608/amj.2022.258347
Nakayama H, Ishikawa T, Yamashita S, Fukui I, Mutoh T, Hikichi K, et al. [CSF leakage and anosmia in aneurysm clipping of anterior communicating artery by basal interhemispheric approach]. No Shinkei Geka. 2011 Mar;39(3):263–8.
Huang X, Yan G, Qin Z, Zhu G. To clip or to coil for unruptured intracranial aneurysm?: A protocol of randomized controlled trial. Medicine (Baltimore). 2021 Mar 19;100(11):e24692. https://doi.org/10.1097/MD.0000000000024692
Guo X. Predictive Factors for Postoperative Cerebrospinal Fluid Drainage in Neurosurgical Management of Intracranial Aneurysms. World Neurosurg. 2025 June;198:123913. https://doi.org/10.1016/j.wneu.2025.123913
Belavadi R, Gudigopuram SVR, Raguthu CC, Gajjela H, Kela I, Kakarala CL, et al. Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms. Cureus [Internet]. 2021 Dec 17. https://doi.org/10.7759/cureus.20478
Darsaut TE, Findlay JM, Bojanowski MW, Chalaala C, Iancu D, Roy D, et al. A Pragmatic Randomized Trial Comparing Surgical Clipping and Endovascular Treatment of Unruptured Intracranial Aneurysms. Am J Neuroradiol. 2023 June;44(6):634–40. https://doi.org/10.3174/ajnr.A7865
Ferns SP, Sprengers MES, Van Rooij WJ, Rinkel GJE, Van Rijn JC, Bipat S, et al. Coiling of Intracranial Aneurysms: A Systematic Review on Initial Occlusion and Reopening and Retreatment Rates. Stroke [Internet]. 2009 Aug [cited 2025 Sept 22];40(8). Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.109.553099. https://doi.org/10.3174/ajnr.A7865
Gonzalez N, Sedrak M, Martin N, Vinuela F. Impact of Anatomic Features in the Endovascular Embolization of 181 Anterior Communicating Artery Aneurysms. Stroke. 2008 Oct;39(10):2776–82.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Abdul Wajid, Usman Ahmad, Nabeel Ashraf Cheema, Hammad Nasir, Anosh John, Tehreem Asif