Variability Between Hydrogel-Based Coiling and Bare Platinum Coiling in the Treatment of Cerebral Aneurysms: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: Recently, hydrogel-based coils are increasingly being discussed as alternatives to bare platinum coils in the treatment of aneurysms. Limited research comparing both cohorts has made it challenging to understand treatment differences. Therefore, our objective was to systematically evaluate previous and recent literature comparing both groups. Methods: The included patient cohorts were selected from randomized controlled trials (RCTs) occurring after 2010. Primary endpoints were immediate occlusion, retreatment and aneurysm recurrence rates. Secondary endpoints include occlusion rate at follow-up, morbidity, mortality and modified Rankin scale (mRS) scores (0–2) post-treatment. R Studio Version 2025.09.0 + 387 was used for statistical analysis and plot generation. Results: Six RCTs were included in the final version for analysis, including a total of 2551 patients with 1278 patients in the hydrogel-based coiling (HBC) group and 1273 patients in the bare platinum coiling (BPC) group. Mean age was 55.84 and 56.89 in the HBC and BPC groups, respectively. Immediate occlusion and retreatment rates revealed nonsignificant difference between both groups ( p = 0.1197, p = 0.2135, respectively). On the other hand, there were significantly lower aneurysm recurrence rates in the HBC cohort ( p = 0.009). Secondary endpoint analysis showed significantly higher follow-up occlusion rates in the HBC cohort ( p = 0.002). All other secondary endpoints, including morbidity, mortality, mRS scores 0–2 and complications, showed comparable results. Conclusion: The results of our study, combined with the small amount of data available, make it challenging to draw conclusions on the superior method of coiling. Further research and controlled trials will be useful to increasingly understand the efficacy and safety profile of HBC.