Unruptured Intracranial Aneurysm: Clipping vs. Endovascular Treatment
Microsurgical clipping or endovascular treatment? For unruptured aneurysms, the only specific randomized trial is CURES. In it, treatment failure at one year was 9% with clipping versus 19% with endovascular treatment, with the same overall morbidity and mortality at one year.
Clipping involves more invasiveness at the outset, with more transient neurological deficits and longer hospital stays. In return it offers highly durable occlusion: 98.6% recurrence-free at 15 years. Endovascular treatment, by contrast, requires lifelong imaging follow-up and more frequent retreatment. Moreover, in unruptured aneurysms, clipping is already less expensive from the initial hospital stay.
In this evidence framework I rank the sources by hierarchy and compare the three techniques. I propose criteria for choosing which one to recommend in each case, always with an individualized decision made by a multidisciplinary committee.
Download the full evidence framework in PDF:
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