Abstract TP244: Coil Embolization or Clipping for Elderly Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Introduction: Although older patients with subarachnoid hemorrhage (SAH) are often preferentially treated with coiling, in practice, there are insufficient data to support a clear benefit of coiling in this population. We aimed to do a meta-analysis comparing clipping with coil embolization for treatment of SAH in elderly people. Methods: We systematically searched Pubmed, Embase and Cochrane databases for studies that compared clipping with coiling for treatment of patients ≥ 60 years old with SAH. Our main endpoint was a compound unfavorable outcome that included Modified Rankin Score (mRS) >2, Glasgow Outcome Scale (GOS) < 4, death or dependency. Other endpoints were an unfavorable outcome in the GOS, mortality and a favorable outcome in the mRS separately. Heterogeneity was assessed with I 2 statistics. Results: We included 25 studies, two randomized, with a total of 49,540 patients, of whom 19,263 (38.8%) were treated with coil embolization. In pooled analysis, there was no statistical difference in the compound unfavorable outcome (RR 1.06; 95%CI 0.79-1.01; p = 0.15; I 2 =56%), GOS (RR 0.88; 95%CI 0.68- 1.14; p = 0.02; I 2 = 55%) and mRS (RR 0.97; 95%CI 0.88- 1.08; p = 0.61; I 2 = 20%). However, all-cause mortality was more common in patients treated with coiling (RR 1.14; 95%CI 1.01- 1.28; p = 0.03; I 2 = 35%). In randomized studies, although not significant, the point estimate seems to favor coiling whereas in observational studies it happened to clipping. Conclusions: The results of our meta-analysis suggest that clipping is a better treatment for SAH in elderly patients regarding all-cause mortality. Otherwise, the endpoints GOS, mRS and compound unfavorable outcome didn't show significant difference between the groups.