title: Endovascular Treatment of Ruptured Blister-Like Aneurysms: A Systematic Review and Meta-Analysis with Focus on Deconstructive versus Reconstructive and Flow-Diverter Treatments.
abstract: OBJECTIVE
  Various endovascular techniques have been applied to treat blister-like aneurysms. We performed a systematic review to evaluate endovascular treatment for ruptured blister-like aneurysms.
  
  
  METHODS
  We performed a comprehensive literature search and subgroup analyses to compare deconstructive versus reconstructive techniques and flow diversion versus other reconstructive options.
  
  
  RESULTS
  Thirty-one studies with 265 procedures for ruptured blister-like aneurysms were included. Endovascular treatment was associated with a 72.8% (95% CI, 64.2%-81.5%) mid- to long-term occlusion rate and a 19.3% (95% CI, 13.6%-25.1%) retreatment rate. Mid- to long-term neurologic outcome was good in 76.2% (95% CI, 68.9%-8.4%) of patients. Two hundred forty procedures (90.6%) were reconstructive techniques (coiling, stent-assisted coiling, overlapped stent placement, flow diversion) and 25 treatments (9.4%) were deconstructive. Deconstructive techniques had higher rates of initial complete occlusion than reconstructive techniques (77.3% versus 33.0%, P = .0003) but a higher risk for perioperative stroke (29.1% versus 5.0%, P = .04). There was no difference in good mid- to long-term neurologic outcome between groups, with 76.2% for the reconstructive group versus 79.9% for the deconstructive group (P = .30). Of 240 reconstructive procedures, 62 (25.8%) involved flow-diverter stents, with higher rates of mid- to long-term complete occlusion than other reconstructive techniques (90.8% versus 67.9%, P = .03) and a lower rate of retreatment (6.6% versus 30.7%, P < .0001).
  
  
  CONCLUSIONS
  Endovascular treatment of ruptured blister-like aneurysms is associated with high rates of complete occlusion and good mid- to long-term neurologic outcomes in most patients. Deconstructive techniques are associated with higher occlusion rates but a higher risk of perioperative ischemic stroke. In the reconstructive group, flow diversion carries a higher level of complete occlusion and similar clinical outcomes.
authors.affiliation: From the Department of Radiology, Mayo Clinic, Rochester, Minnesota. Rouchaud.Aymeric@mayo.edu aymeric.rouchaud@gmail.com.
authors.forename: A
authors.identifier: http://orcid.org/0000-0003-0902-3375
authors.initials: A
authors.lastname: Rouchaud
authors.affiliation: From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: W
authors.identifier: http://orcid.org/0000-0001-5271-5524
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: H J
authors.identifier: http://orcid.org/0000-0003-2590-3815
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: D F
authors.identifier: http://orcid.org/0000-0002-8495-0040
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome