Clinical outcomes of microvascular clipping compared to endovascular coiling for ruptured anterior communicating artery aneurysms: a systematic review protocol

Objective: This review will evaluate the effectiveness of microsurgical clipping versus endovascular treatment of ruptured anterior communicating artery aneurysms in adults.

Introduction: Subarachnoid hemorrhage secondary to anterior communicating artery aneurysm rupture is a catastrophic event leading to significant neurological morbidity and mortality. The clinical outcomes of microsurgical clipping versus endovascular coiling have been reported in systematic reviews for other intracranial aneurysm locations, including middle cerebral artery and posterior communicating artery aneurysms. A systematic review is necessary to evaluate the functional, angiographic, and safety outcomes of endovascular management versus microsurgical clipping for treatment guidance.

Inclusion criteria: Patients aged 18 years and over with a ruptured anterior communicating artery aneurysm will be included. Patients may have intracranial aneurysms in other locations; however, they will only be included if a ruptured anterior communicating artery aneurysm has occurred and only if that aneurysm has been treated. Interventions of interest are microsurgical clipping compared to endovascular treatment.

Methods: The following databases will be searched: PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials. Experimental, quasi-experimental, and analytical observational studies will be considered. Studies in all languages will be included if they can be translated. Two independent reviewers will retrieve and assess relevant studies using JBI's standardized critical appraisal instruments. Extracted data will include Glasgow Outcome Scale/Modified Rankin Score, angiographic occlusion, aneurysm recurrence, intra-operative thromboembolic event rates, post-operative complications, and post-operative aneurysm recurrence rates. Studies will, where possible, be pooled using statistical meta-analysis. Outcomes assessed will include functional status, angiographic occlusion rates, incidence of aneurysm recurrence, and safety of treatment.