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Review
. 2025 Jun 12:19714009251346467.
doi: 10.1177/19714009251346467. Online ahead of print.

Endovascular or microsurgical? Defining the best approach for blood blister aneurysms: A comparative meta-analysis

Filipi Fim Andreão  1 , Helvécio Neves Feitosa Filho  2 , Emanuel Abrantes Barros  3 , José Gabriel Abreu Moreira  4 , Matheus Hemais  3 , Ary Rodrigues Neto  5 , Luiz Guilherme Silva Almeida  6 , Niels Pacheco-Barrios  7   8 , Thayne Alexsandra Carneiro  9 , Vitor Salviato Nespoli  10 , Fausto Braga  11 , Cesar Augusto Alves Ferreira Filho  11 , Elias Tanus  11 , José Alberto Almeida Filho  11
Affiliations
Review

Endovascular or microsurgical? Defining the best approach for blood blister aneurysms: A comparative meta-analysis

Filipi Fim Andreão et al. Neuroradiol J. .

Abstract

IntroductionBlood 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.MethodsA 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 I2 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.ResultsFifteen 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.ConclusionDespite microsurgery being traditionally used in BBLAs management, EVT has been shown to be a safer and lower-morbidity option.

Keywords: Aneurysm; blister; endovascular; hemorrhage; microsurgery.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Prisma flow diagram.
Figure 2.
Figure 2.
Risk of bias of the included studies using the ROBINS-I tool.
Figure 3.
Figure 3.
(3A) Good clinical outcomes given by final mRs postoperatively (0–2) and (3B) Poor clinical outcomes given by final mRs postoperatively (3–6).
Figure 4.
Figure 4.
(4A) Epilepsy outcome after treatment; (4B) Infection complication after intervention; (4C) Intracranial hemorrhage postoperative; (4D) Vasospasm occurrence.
Figure 5.
Figure 5.
(a) Ischemic events in the treated groups; (b) Mortality; (c) Operative rupture of aneurysms.
Figure 6.
Figure 6.
(a) Rebleeding after microsurgery or EVT; (b) Recurrence of aneurysms; (c) Necessity of retreatment after microsurgery and EVT.
See this image and copyright information in PMC

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