BRIEF RESEARCH REPORT article
Front. Radiol.
Sec. Interventional Radiology
This article is part of the Research TopicAdvances in Emergency Interventional Radiology: Techniques, Outcomes, and Future DirectionsView all 5 articles
Endovascular Coiling Versus Surgical Clipping for Ruptured Intracranial Aneurysms: An In-Hospital Outcome Win Ratio Analysis from a Colombian Tertiary Center
Provisionally accepted
- 1Centro de Investigaciones Clínicas, Fundacion Valle del Lili, Cali, Colombia
- 2Departamento de Radiología, Fundacion Valle del Lili, Cali, Colombia
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Background: The optimal management approach for ruptured intracranial aneurysms remains debated, with limited real-world evidence from Latin American populations. This study compared in-hospital outcomes between endovascular coiling and surgical clipping using a hierarchical win ratio (WR) analysis. Methods: We conducted a single-center retrospective cohort study of 194 patients with ruptured intracranial aneurysms treated at a tertiary referral center (2011-2022). Patients were treated with either endovascular coiling (n=73) or surgical clipping (n=121). The primary outcome was the win ratio, analyzing a hierarchical composite endpoint of: (1) in-hospital mortality, (2) unfavorable functional outcome at discharge (modified Rankin Scale >2), (3) major complications, and (4) prolonged ICU stay (>10 days). Secondary analyses included multivariable logistic regression and prespecified subgroup analyses by clinical severity and aneurysm location. Results: The win ratio significantly favored endovascular coiling (WR 1.75, 95% CI: 1.67-1.84, p<0.001). All individual components also favored coiling: mortality (WR=1.35), unfavorable functional outcome (WR=1.53), major complications (WR=1.70), and prolonged ICU stay (WR=1.25) (all p<0.001). Benefits were consistent across clinical severity subgroups. In contrast, multivariable analysis showed only a non-significant trend for coiling (OR=0.55, p=0.102), while confirming Hunt & Hess ≥3 (OR=5.54, p<0.001) and modified Fisher ≥3 (OR=3.85, p=0.044) as dominant prognostic factors. Conclusion: In this Colombian cohort, hierarchical outcome analysis suggested superior in-hospital outcomes for endovascular coiling versus surgical clipping. However, the substantial attenuation of this association in adjusted analyses indicates that these apparent advantages may largely reflect case selection patterns rather than inherent treatment superiority, as residual confounding by aneurysm complexity cannot be excluded.
Keywords: Intracranial Aneurysm, Subarachnoid Hemorrhage, endovascular coiling, Surgical clipping, Win ratio, outcomes research, Latin America
Received: 12 Aug 2025; Accepted: 25 Nov 2025.
Copyright: © 2025 Quiceno-Ramirez, García-Pretelt, Mejia-Quiñones and Folleco-Pazmiño. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Edgar Folleco-Pazmiño
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