ABSTRCAT
Background: Despite his youth and lack of experience, aneurysms were one of the most serious challenges for neurosurgeons because of their risk of rupture and their potentially fatal consequences. For decades, two dominant modalities—microsurgical clipping and endovascular coiling—had garnered experience, each with unique strengths and weaknesses. Whereas clipping had traditionally provided complete exclusion of an aneurysm, coiling became the most common treatment choice for a wide range of aneurysm sizes, but in a minimally-invasive manner. Comparison of these strategies was necessary to identify the best outcomes for patients.
Objectives: The purpose of this study was to compare the short- and long-term surgical results, complications, and prognosis of patients with aneurysms treated by clipping and coil.
Material & Methods: This was a cross-sectional study conducted during the period between October 2024 to September 2025 at Pakistan Institute of Medical Sciences (PIMS), Islamabad. This was a prospective cohort study with a convenience sample including 100 patients with IA. Participants were divided into two groups according to the surgical modality: clipping (n = 50) and coiling (n = 50). Demographic characteristics, clinical presentation, surgical outcome, postoperative complications, and follow-up data were recorded. Statistical analysis was used to compare morbidity, mortality, recurrence, and functional outcomes between groups.
Results: The intraoperative complication rates were more common in the clipping group (16%) compared to the coiling group (10%) but this finding was not statistically significant. Clipping indeed has shown better long-term rates of aneurysm obliteration (92% vs. 82%). The coiling group also had shorter hospital stays and quicker recovery times, with 80 percent of patients returning to daily activities within three months versus 66 percent in the clipping group. Mortality rates were somewhat increased among patients assigned to clipping compared with coiling (6% vs 4%), but modified Rankin Scale (mRS) scores at 12 months were similar between clipping and coiling modes of therapy.
Conclusion: Both clipping and coiling were safe and comparably effective aneurysm management strategies with important procedural differences. Clipping had seemed to offer better long-term aneurysm exclusion, whereas coiling appeared to offer superior short-term recovery with less hospital stay. Depending on the aneurysm characteristics, the patient’s condition and the surgical expertise, the treatment choice had not always been the same. The need for a multidisciplinary approach was key in customizing therapeutic strategies to get best results.
Keywords: Aneurysm, Surgical clipping, Endovascular coiling, Intracranial aneurysms, Neurosurgery, Patient outcomes.