Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy

Abstract

OBJECTIVE Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) have a poor natural history associated with high morbidity and mortality. Currently, both surgical and endovascular techniques are employed to treat BBAs; thus, the authors sought to perform a meta-analysis to compare the efficacy and safety of these approaches. METHODS A literature search of PubMed, MEDLINE, and Google Scholar online databases was performed to include pertinent English-language studies from 2005 to 2015 that discussed the efficacy and safety of either surgical or endovascular therapies to treat BBAs. RESULTS Thirty-six papers describing 256 patients with BBAs treated endovascularly (122 procedures) or surgically (139 procedures) were examined for data related to therapeutic efficacy and safety. Pooled analysis of 9 papers demonstrated immediate and late (mean 20.9 months) aneurysm occlusion rates of 88.9% (95% CI 77.6%-94.8%) and 88.4% (95% CI 76.7%-94.6%), respectively, in surgically treated patients. Pooled analysis of 12 papers revealed immediate and late aneurysm obliteration rates of 63.9% (95% CI 52.3%-74.1%) and 75.9% (95% CI 65.9%-83.7%), respectively, in endovascularly treated aneurysms. Procedure-related complications and overall poor neurological outcomes were slightly greater in the surgically treated cases than in the endovascularly treated cases (27.8% [95% CI 19.6%-37.8%] vs 26.2% [95% CI 18.4%-35.8%]), indicating that endovascular therapy may provide better outcomes. CONCLUSIONS Blood-blister aneurysms are rare, challenging lesions with a poor prognosis. Although surgical management potentially offers superior aneurysm obliteration rates immediately after treatment and at the long-term follow-up, endovascular therapy may have a better safety profile and provide better functional outcomes than surgery. A registry of patients treated for BBAs may be warranted to better document the natural course of the disease as well as treatment outcomes.

Four-Year Experience Using an Advanced Interdisciplinary Hybrid Operating Room : Potentials in Treatment of Cerebrovascular Disease

“…For complex intracranial aneurysms, combined microsurgical and endovascular technique could provide relatively simple and safe treatment strategies [3]. Direct clipping of BBA usually has a relatively high rate of intraoperative aneurysm rupture during acute phase surgery [21,22]. Although the endovascular procedure is presented as an alternative, there is a relatively high probability of rupture during coil embolization and recurrence even after treatment [22].…”

“…Direct clipping of BBA usually has a relatively high rate of intraoperative aneurysm rupture during acute phase surgery [21,22]. Although the endovascular procedure is presented as an alternative, there is a relatively high probability of rupture during coil embolization and recurrence even after treatment [22]. Thus, trapping of ICA involving BBA with/without bypass surgery is considered to be a relatively safe and complete procedure to treat BBA [8,9].…”

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

“…Most think that it is a dissecting lesion, when some argue that it is in fact a false lesion. One way or the other, it is a consensus that blister aneurysm has a focal vessel-wall defects, adventitial lining without collagen matrix, explaining its critical course and reserved prognosis (1,4,(12)(13)(16)(17) .…”

“…Most authors debate about all these characteristics, without a clear homogeneous opinion. Shah at al, 2017 (12) and Meling, 2017 (13) performed meta-analysis, while Ren at al, 2018 (2) performed a retrospective study, concluding that surgery has superior obliteration rates and similar neurological outcomes -comparing to the endovascular treatment -coming at the price of higher complication rate mostly because of higher rupture rate, vasospasm, hydrocephalus and infarction. Endovascular management offers superior safety, but higher retreatment rates and lower obliteration.…”

“…Overall, they represent 0.3% -1.0% of all intracranial aneurysms and 0.9% -6.5% of all ruptured intracranial aneurysms (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) . They are associated with high morbidity and mortality (9,12,13) . If we compare them to the saccular aneurysm, it is noticed that they affect a younger population (1,3,13) .…”