title: 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.
authors.forename: Sumedh S
authors.initials: SS
authors.lastname: Shah
authors.forename: Zachary C
authors.initials: ZC
authors.lastname: Gersey
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nuh
authors.forename: Hesham T
authors.initials: HT
authors.lastname: Ghonim
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.forename: Eric C
authors.initials: EC
authors.lastname: Peterson
mesh_terms: D002343:Carotid Artery, Internal / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: BBA = blood-blister aneurysm; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; aneurysm; blood-blister aneurysm; endovascular; internal carotid artery; mRS = modified Rankin Scale; meta-analysis; microsurgical technique; vascular disorders