COMPARATIVE ANALYSIS OF EARLY VERSUS DELAYED ENDOVASCULAR COILING FOR RUPTURED INTRACRANIAL ANEURYSMS: CLINICAL OUTCOMES AND PRE-PROCEDURAL STRATEGIES

Abstract

Abstract Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurologic emergency with high mortality and disability. Prompt aneurysm securing is essential to reduce the risk of rebleeding, yet the optimal timing of endovascular coiling remains debated—especially in patients with varying neurological grades or complex aneurysm morphology. Objective: This systematic review and meta-analysis aimed to compare early (<72 hours) versus delayed (≥72 hours) endovascular coiling in ruptured intracranial aneurysms, assessing mortality, functional independence, rebleeding risk, and procedural complications including vasospasm or delayed cerebral ischemia (DCI). Methods: A systematic search of PubMed, Scopus, Embase, and Cochrane Library was performed for studies published between January 2020 and May 2025. Studies comparing early versus delayed coiling with clinical outcome data were included. Meta-analysis was conducted using RevMan 5.4 with pooled odds ratios (ORs) and 95% confidence intervals (CIs). Results: Eleven studies encompassing 2,306 patients were included. Early coiling was associated with significantly lower mortality (OR = 0.71; 95% CI: 0.55–0.92; p = 0.008), reduced rebleeding risk (OR = 0.52; 95% CI: 0.35–0.77; p = 0.001), and higher rates of functional independence (OR = 1.32; 95% CI: 1.08–1.60; p = 0.005). There was no significant difference in vasospasm/DCI between groups (OR = 1.05; 95% CI: 0.82–1.35; p = 0.69). Publication bias was not significant (Egger’s test, p = 0.22). Conclusion: Early endovascular coiling within 72 hours of rupture is associated with better clinical outcomes—particularly in patients with good-grade aSAH—without increasing vasospasm or DCI risk. Advances in adjunctive endovascular techniques and peri-procedural strategies have expanded the feasibility and safety of early treatment, even in complex cases. Early coiling should be considered the preferred timing strategy in eligible patients and supported by institutional protocols and infrastructure.