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Meta-Analysis
. 2015 Dec;36(12):2331-9.
doi: 10.3174/ajnr.A4438. Epub 2015 Sep 17.

Endovascular Treatment of Ruptured Blister-Like Aneurysms: A Systematic Review and Meta-Analysis with Focus on Deconstructive versus Reconstructive and Flow-Diverter Treatments

A Rouchaud  1 , W Brinjikji  2 , H J Cloft  2 , D F Kallmes  2
Affiliations
Meta-Analysis

Endovascular Treatment of Ruptured Blister-Like Aneurysms: A Systematic Review and Meta-Analysis with Focus on Deconstructive versus Reconstructive and Flow-Diverter Treatments

A Rouchaud et al. AJNR Am J Neuroradiol. 2015 Dec.

Abstract

Background and purpose: 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.

Materials and 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.

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Figures

Fig 1.
Fig 1.
Meta-analysis. Comparison of initial occlusion rates between deconstructive and reconstructive techniques.
Fig 2.
Fig 2.
Meta-analysis. Comparison of the perioperative stroke rate between deconstructive and reconstructive techniques.
Fig 3.
Fig 3.
Meta-analysis. Comparison of mid- to long-term occlusion rates between non-flow-diverter reconstructive techniques and flow-diverter techniques.
Fig 4.
Fig 4.
Meta-analysis. Comparison of retreatment rates between non-flow-diverter reconstructive techniques and flow-diverter techniques.
See this image and copyright information in PMC

References

    1. Nakagawa F, Kobayashi S, Takemae T, et al. . Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 1986;65:303–08 10.3171/jns.1986.65.3.0303 - DOI - PubMed
    1. McLaughlin N, Laroche M, Bojanowski MW. Blister-like aneurysms of the internal carotid artery: management considerations. Neurochirurgie 2012;58:170–86 10.1016/j.neuchi.2012.02.025 - DOI - PubMed
    1. Ahn JY, Cho JH, Jung JY, et al. . Blister-like aneurysms of the supraclinoid internal carotid artery: challenging endovascular treatment with stent-assisted coiling. J Clin Neurosci 2008;15:1058–61 10.1016/j.jocn.2007.03.021 - DOI - PubMed
    1. Gonzalez AM, Narata AP, Yilmaz H, et al. . Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 2014;83:197–205 10.1016/j.ejrad.2013.09.017 - DOI - PubMed
    1. Abe M, Tabuchi K, Yokoyama H, et al. . Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 1998;89:419–24 10.3171/jns.1998.89.3.0419 - DOI - PubMed

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