Treatment of intracranial aneurysms by embolization with coils - A systematic review

Background-Embolization with coils is increasingly used for the treatment o f intracranial aneurysms. To assess the percentage of complications, the pe rcentage of aneurysm occlusion, and the short-term outcome, we performed a systematic review of studies on embolization with controlled detachable or pushable coils. Summary of Review-To find studies on embolization with coils, we performed a MEDLINE search from January 1990 to March 1997, checked all reference lis ts of the studies found, performed a Science Citation Index search on Gugli elmi, and hand searched recent volumes of 25 journals. Two authors independ ently extracted data by means of a standardized data extraction form from 4 8 eligible studies totalling 1383 patients. permanent complications of embo lization with controlled detachable coils occurred in 46 of 1256 patients ( 3.7%; 95% CI, 2.7% to 4.9%); 400 of 744 aneurysms (54%; 95% CI, 50% to 57%) were completely occluded. By means of weighted linear regression, no relat ion between baseline characteristics and outcome measurements was found. Th e results in the prespecified subgroups of patients with a ruptured aneurys m, an unruptured aneurysm, or a basilar bifurcation aneurysm were essential ly the same as the overall results. Conclusions-Short-term results indicate that embolization with coils is a r easonably safe treatment for patients with an unruptured aneurysm and for p atients with aneurysmal subarachnoid hemorrhage. The effectiveness in terms of complete occlusion of the aneurysm is moderate. Randomized trials are w arranted to compare surgical clipping with embolization with coils.