Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery

Systematic review of literature and meta-analysis on safety and efficacy

Sumedh S. Shah, Zachary C. Gersey, Mohamed Nuh, Hesham T. Ghonim, Mohamed Elhammady, Eric Peterson

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1361-1363
Number of pages3
JournalJournal of Neurosurgery
Volume127
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Internal Carotid Artery
Blister
Aneurysm
Meta-Analysis
Safety
Therapeutics
Endovascular Procedures
Natural History
PubMed
MEDLINE
Registries
Language
Databases
Morbidity
Mortality

Keywords

  • Aneurysm
  • Blood-blister aneurysm
  • Endovascular
  • Internal carotid artery
  • Meta-analysis
  • Microsurgical technique
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery : Systematic review of literature and meta-analysis on safety and efficacy. / Shah, Sumedh S.; Gersey, Zachary C.; Nuh, Mohamed; Ghonim, Hesham T.; Elhammady, Mohamed; Peterson, Eric.

In: Journal of Neurosurgery, Vol. 127, No. 6, 01.12.2017, p. 1361-1363.

Research output: Contribution to journalArticle

Shah, Sumedh S. ; Gersey, Zachary C. ; Nuh, Mohamed ; Ghonim, Hesham T. ; Elhammady, Mohamed ; Peterson, Eric. / Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery : Systematic review of literature and meta-analysis on safety and efficacy. In: Journal of Neurosurgery. 2017 ; Vol. 127, No. 6. pp. 1361-1363.
@article{5bb629caf346419cbae35a7750cbc619,
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.",
keywords = "Aneurysm, Blood-blister aneurysm, Endovascular, Internal carotid artery, Meta-analysis, Microsurgical technique, Vascular disorders",
author = "Shah, {Sumedh S.} and Gersey, {Zachary C.} and Mohamed Nuh and Ghonim, {Hesham T.} and Mohamed Elhammady and Eric Peterson",
year = "2017",
month = "12",
day = "1",
doi = "10.3171/2016.9.JNS161526",
language = "English (US)",
volume = "127",
pages = "1361--1363",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "6",

}

TY - JOUR

T1 - Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery

T2 - Systematic review of literature and meta-analysis on safety and efficacy

AU - Shah, Sumedh S.

AU - Gersey, Zachary C.

AU - Nuh, Mohamed

AU - Ghonim, Hesham T.

AU - Elhammady, Mohamed

AU - Peterson, Eric

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

KW - Aneurysm

KW - Blood-blister aneurysm

KW - Endovascular

KW - Internal carotid artery

KW - Meta-analysis

KW - Microsurgical technique

KW - Vascular disorders

UR - http://www.scopus.com/inward/record.url?scp=85029187721&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029187721&partnerID=8YFLogxK

U2 - 10.3171/2016.9.JNS161526

DO - 10.3171/2016.9.JNS161526

M3 - Article

VL - 127

SP - 1361

EP - 1363

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 6

ER -