Microsurgical Clipping Compared with New and Most Advanced Endovascular Techniques in the Treatment of Unruptured Middle Cerebral Artery Aneurysms: A Meta-Analysis in the Modern Era

Rapid technological advances in endovascular neurosurgery have shaped treatment of intracranial aneurysms in the past 3 decades. The main limitation of endovascular surgery for complex and wide-neck aneurysms has been the risk of recurrence and risks associated with compromise of the parent artery and/or arterial branches incorporated in the neck of the aneurysm. With the availability of newer and more advanced devices used as stand-alone tools or in combination, aneurysms with complex geometry and a wide neck can be effectively treated with endovascular techniques.1, 2, 3 These rapid changes are leading to a paradigm shift in the treatment of middle cerebral artery aneurysms (MCAAs), which for a long time have been considered to be better treated with open surgical clipping. Because of the rapidly changing field, there are scant data on the overall effectiveness of newer tools and techniques in the endovascular treatment of MCAAs compared with surgical clipping. The objective of this meta-analysis is to compare clipping of unruptured MCAAs with the most up-to-date endovascular techniques (i.e., stent-assisted coiling [SAC], flow diverter, and endosaccular devices) in terms of occlusion, complications rate, and clinical results.