Endovascular or microsurgical? Defining the best approach for blood blister aneurysms: A comparative meta-analysis
Year: 2025
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Introduction Blood blister-like aneurysms (BBLAs) are rare, typically found in the anteromedial supraclinoid segment of the internal carotid artery, and are related to high morbidity and mortality rates. Although microsurgery has been traditionally used to manage BBLAs, the Endovascular treatment (EVT) is gaining importance. We aim to compare these two methods using a systematic review and meta-analysis. Methods A systematic search of PubMed, Embase, and Web of Science databases following PRISMA guidelines was conducted. We pooled odds ratios (OR) with 95% confidence intervals using a random-effects model, and I 2 to assess heterogeneity. Eligible studies compared microsurgery and EVT for BBLAs. Outcome measures included Good and Poor clinical outcomes by Modified Rankin Scale (mRS), Epilepsy, Infection, Intracranial Hemorrhage, Vasospasm, Ischemic Events, Mortality, Operative Rupture, Rebleeding, Recurrence, and Retreatment. Results Fifteen studies with 770 patients were included (401 microsurgery; 369 EVT). EVT appeared to be protective against Poor Clinical Outcomes (mRS >2), with an OR of 0.43 (95% CI 0.21 to 0.87), and Ischemic Events, having an OR of 0.33 (95% CI 0.18 to 0.61). Microsurgery was related to higher Mortality, with an OR of 2.72 (95% CI 1.46 to 5.06), and Operative Rupture, with 7.72 (95% CI 3.50 to 17.07). EVT also statistically favored the Good Clinical Outcomes analysis, with an OR of 3.13 (95% CI 1.40 to 6.98). Epilepsy, Infection, Intracranial Hemorrhage, and Vasospasm occurrence showed no significant statistical difference. Conclusion Despite microsurgery being traditionally used in BBLAs management, EVT has been shown to be a safer and lower-morbidity option.
Source: The Neuroradiology Journal
Authors: Filipi Fim Andreão, Helvécio Neves Feitosa Filho, Emanuel Abrantes Barros, José Gabriel Abreu Moreira, Matheus Hemais, Ary Rodrigues Neto, Luiz Guilherme Silva Almeida, Niels Pacheco-Barrios, Thayne Alexsandra Carneiro, Vitor Salviato Nespoli, Fausto Braga, Cesar Augusto Alves Ferreira Filho, Elias Tanus, José Alberto Almeida Filho
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4411290302