Vanegas-Mondragon Tellez-Tellez 2025b - Revision history

A.Vamond: A.Vamond moved page Vanegas-Mondragon Tellez-Tellez 2025a to Vanegas-Mondragon Tellez-Tellez 2025b

2025-09-06T20:28:33Z

A.Vamond moved page Vanegas-Mondragon Tellez-Tellez 2025a to Vanegas-Mondragon Tellez-Tellez 2025b

A.Vamond: A.Vamond moved page Draft Vanegas-Mondragon 936604968 to Vanegas-Mondragon Tellez-Tellez 2025a

2025-09-06T20:28:08Z

A.Vamond moved page Draft Vanegas-Mondragon 936604968 to Vanegas-Mondragon Tellez-Tellez 2025a

A.Vamond at 20:24, 6 September 2025

2025-09-06T20:24:10Z

A.Vamond: Added appendices

2025-09-06T20:20:08Z

Added appendices

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A.Vamond at 07:21, 3 September 2025

2025-09-03T07:21:03Z

A.Vamond at 07:19, 3 September 2025

2025-09-03T07:19:22Z

A.Vamond at 07:16, 3 September 2025

2025-09-03T07:16:55Z

A.Vamond at 07:15, 3 September 2025

2025-09-03T07:15:11Z

A.Vamond: Created page with "

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 ==Abstract==
-Intracranial aneurysms are a leading cause of subarachnoid hemorrhage (SAH), associated with high morbidity and mortality. Traditionally, microsurgical clipping was the gold standard, but endovascular coiling has emerged as a less invasive alternative. This review synthesizes current evidence comparing endovascular and surgical approaches. A systematic search was conducted across PubMed, Scopus, and the Cochrane Library, including randomized controlled trials (RCTs) and cohort studies published between 2000 and 2025. Outcomes assessed were mortality, functional independence, perioperative complications, recurrence, and retreatment rates. Twenty-seven studies encompassing 18,560 patients were analyzed. Endovascular therapy demonstrated reduced short-term mortality and higher rates of functional independence, particularly in elderly patients and those with posterior circulation aneurysms. Conversely, surgical clipping ensured greater long-term durability with fewer retreatments, especially among younger patients. Both techniques carry unique benefits and limitations; thus, treatment should be individualized, taking into account aneurysm morphology, patient age, comorbidities, and surgical risk. Risk of bias assessment was performed using Cochrane RoB2 for RCTs and the Newcastle-Ottawa Scale for observational studies, with most studies showing moderate risk. This review highlights the importance of a multidisciplinary, patient-centered approach, while emphasizing the need for future long-term RCTs and device innovations. In conclusion, endovascular therapy provides superior early safety, while surgical clipping ensures durable occlusion; an evidence-based, personalized strategy remains essential to optimize patient outcomes.
+'''Objective'''
 ==Introduction==

← Older revision		Revision as of 07:21, 3 September 2025
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−	Primary outcomes~~<br/><br/>~~Mortality: Endovascular therapy reduced short-term mortality compared with clipping (OR 0.78; 95% CI, 0.66–0.93).<br/><br/>Functional independence (mRS ≤2 at 1 year): Endovascular therapy increased the likelihood of good outcomes (OR 1.23; 95% CI, 1.08–1.42).<br/><br/>See Figure 2 (Forest Plot – Mortality) and Figure 3 (Forest Plot – Functional Independence).	+	===Primary outcomes===
		+
		+	Mortality: Endovascular therapy reduced short-term mortality compared with clipping (OR 0.78; 95% CI, 0.66–0.93).<br/><br/>Functional independence (mRS ≤2 at 1 year): Endovascular therapy increased the likelihood of good outcomes (OR 1.23; 95% CI, 1.08–1.42).<br/><br/>See Figure 2 (Forest Plot – Mortality) and Figure 3 (Forest Plot – Functional Independence).

	===Secondary outcomes===		===Secondary outcomes===

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 [[Image:Draft_Vanegas-Mondragon_936604968-image1-c.png|center|240px]]
-<div class="center" style="width: auto; margin-left: auto; margin-right: auto;">
-Figure 1: PRISMA 2020 Flow Diagram</div>
+Figure 1: PRISMA 2020 Flow Diagram
 [[Image:Draft_Vanegas-Mondragon_936604968-image2.png|600px]]
@@ Line 111: / Line 111: @@
 Figure 3: Forest Plot – Functional Independence
-==References
+==References==
 . Vlak MH, et al. Prevalence of unruptured intracranial aneurysms. Lancet Neurol. 2011;10(7):626-636.

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 Figure 1: PRISMA 2020 Flow Diagram</div>
-[[Image:Draft_Vanegas-Mondragon_936604968-image2.png|600px]] Figure 2: Forest Plot – Mortality
+[[Image:Draft_Vanegas-Mondragon_936604968-image2.png|600px]]
-[[Image:Draft_Vanegas-Mondragon_936604968-image3.png|600px|alt='Figure 3: Forest Plot – Functional Independence'|Figure 3: Forest Plot – Functional Independence]]
+Figure 2: Forest Plot – Mortality
 Figure 3: Forest Plot – Functional Independence

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 ==Conclusion==
-Endovascular therapy provides superior short-term outcomes, while surgical clipping ensures greater long-term durability. A patient-centered approach is recommended, balancing safety and durability.
+Endovascular therapy has established itself as a less invasive treatment modality, offering superior short-term outcomes such as reduced perioperative morbidity, shorter hospital stays, and faster recovery when compared with surgical clipping. In contrast, microsurgical clipping continues to demonstrate greater long-term durability, with lower recurrence and retreatment rates, particularly in younger patients and in cases where aneurysm morphology is less favorable for endovascular intervention. The choice between these approaches should be individualized, considering patient-specific factors including age, comorbidities, aneurysm location and morphology, as well as life expectancy. A patient-centered, multidisciplinary strategy that incorporates both clinical evidence and shared decision-making is essential to optimize outcomes. Future research with long-term follow-up and advances in device technology are expected to refine therapeutic algorithms and further improve the balance between safety, efficacy, and durability in the management of intracranial aneurysms.
-== [[Image:Draft_Vanegas-Mondragon_936604968-image1-c.png|center|240px]] Figure Legends==
+==Figure Legends==
 <div class="center" style="width: auto; margin-left: auto; margin-right: auto;">

← Older revision	Revision as of 20:28, 6 September 2025
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