Ruptured anterior communicating artery (AComA) aneurysms are a major cause of aneurysmal subarachnoid hemorrhage, and the optimal treatment—microsurgical clipping or endovascular coiling—remains debated.

A systematic review and meta-analysis (PROSPERO CRD420251176980) compared outcomes of clipping versus coiling in adults with ruptured AComA aneurysms. Ten retrospective cohort studies involving 1,450 patients were included. Pooled analyses used random-effects models, and risk of bias was assessed with ROBINS-I.

There were no significant differences between clipping and coiling in favorable discharge outcomes (Glasgow Outcome Scale ≥4), mortality, or major procedural complications. Hospital length of stay was significantly shorter with coiling. Overall heterogeneity was low to moderate, except for length of stay.

Microsurgical clipping and endovascular coiling yield comparable functional and safety outcomes in ruptured AComA aneurysms, while coiling may reduce hospitalization duration. Prospective controlled studies are required to optimize individualized treatment selection.

Article published online:
01 May 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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