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

Andreão F.F.; Feitosa Filho H.N.; Barros E.A.; Abreu Moreira J.G.; Hemais M.; Neto A.R.; Almeida L.G.S.; Pacheco-Barrios N.; Carneiro T.A.; Nespoli V.S.; Braga F.; Alves Ferreira Filho C.A.; Tanus E.; Almeida Filho J.A. · Neuroradiology Journal (2026) · DOI: 10.1177/19714009251346467

Resumen

Introduction: Blood 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. Methods: A 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. Results: Fifteen 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. Conclusion: Despite microsurgery being traditionally used in BBLAs management, EVT has been shown to be a safer and lower-morbidity option. © The Author(s) 2025

Instituciones: Universidad Científica del Sur