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Circulation · November 2, 2026

Abstract 14854: Hyperacute versus Subacute Endovascular Coiling for Ruptured Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Muhammad Talha Khan, Dimash Davletov, Eman Khalid, Ayesha Ejaz, SIRAJ UL MUNEER, Muhammad Maaz

Dimash Davletov
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Abstract

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with substantial morbidity and mortality, largely driven by the risk of early aneurysm rebleeding. Endovascular coiling is an established treatment modality, but the optimal timing of intervention remains controversial. Hyperacute coiling within 24 hours may reduce rebleeding risk and improve outcomes, whereas delayed treatment may allow for greater clinical stabilization. This systematic review and meta-analysis aimed to compare the safety and efficacy of hyperacute (≤24 h) versus subacute (24-72 h) endovascular coiling in adults with ruptured intracranial aneurysms. Methods: A systematic literature search was conducted across electronic databases from inception till May 2026. Studies comparing hyperacute (<24 hours) and subacute (24-72 h) coiling for the treatment of aneurysmal subarachnoid hemorrhage were included. Outcomes included early and long-term mortality, incidence of hydrocephalus, poor and good functional outcome, incidence of rebleeding, and vasospasm. We employed risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes. A random-effects model was applied for all analyses to account for expected between-study variability. Results: We included 9 studies with a total of 3,981 participants. Regarding functional outcomes , there was no statistically significant difference between the groups in achieving a favorable outcome, defined as modified Rankin Scale (mRS) 0-2 (Risk Ratio [RR] 1.11; 95% Confidence Interval [CI] 0.94-1.31; p=0.228), or in the risk of a poor outcome (mRS 3-6) (RR 0.78; 95% CI 0.51-1.19; p=0.245).In terms of neurological complications , the analysis found no significant difference between hyperacute and subacute coiling for rebleeding (RR 0.92; 95% CI 0.27-3.14; p=0.897), vasospasm (RR 1.00; 95% CI 0.71-1.41; p=0.994), or the development of hydrocephalus (RR 1.61; 95% CI 0.92-2.81; p=0.096).Similarly, there was no significant difference in mortality rates between the two treatment windows. This lack of significance was consistent for both early mortality (RR 1.58; 95% CI 0.10-25.24; p=0.746) and long-term mortality (RR 0.74; 95% CI 0.40-1.39; p=0.351) Conclusion: Hyperacute endovascular coiling within 24 hours was not associated with improved mortality, functional outcomes, or major complications compared with subacute coiling performed within 24-72 hours. Larger prospective studies are warranted to identify patient populations that may derive benefit from earlier intervention.

Intracranial Aneurysms: Treatment and ComplicationsIntracerebral and Subarachnoid Hemorrhage ResearchAortic aneurysm repair treatmentsruptured intracranial aneurysmcoil embolizationaneurysmal subarachnoid hemorrhage

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