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Research ArticleNeurointervention
Open Access

A Systematic Review and Meta-Analysis of Treatment and Outcome of Blister-Like Aneurysms

S. Peschillo, D. Cannizzaro, A. Caporlingua and P. Missori
American Journal of Neuroradiology May 2016, 37 (5) 856-861; DOI: https://doi.org/10.3174/ajnr.A4606
S. Peschillo
aFrom the Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology (S.P.)
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D. Cannizzaro
bNeurosurgery (D.C., A.C., P.M.), “Sapienza,” University of Rome, Rome, Italy.
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A. Caporlingua
bNeurosurgery (D.C., A.C., P.M.), “Sapienza,” University of Rome, Rome, Italy.
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P. Missori
bNeurosurgery (D.C., A.C., P.M.), “Sapienza,” University of Rome, Rome, Italy.
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    Fig 1.

    The graph shows the different data concerning antiplatelet therapy administered to patients treated with flow-diverter stents intraoperatively, up to 12 hours before the procedure, and during the first 6 postoperative months. Note that in some cases, this information was missing. These statistics are based on the available data. ASA indicates aspirin.

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    Fig 2.

    The graph shows the different data concerning antiplatelet therapy administered to patients treated with no flow-diverter stent up to 12 hours before the procedure, and during the first 6 postoperative months. Note that in some cases this information was missing. These statistics are based on the available data.

Tables

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    Table 1:

    Distribution of locations of blister-like aneurysms

    Topography(%)
    Internal carotid artery91.6
    Anterior communicating artery2.8
    Middle cerebral artery1.9
    Posterior cerebral artery1.6
    Basilar artery1.6
    Anterior cerebral artery0.3
    Total100
    • View popup
    Table 2:

    Clinical outcomes according to type of treatment and presentation

    Surgery-Only Group Outcome (mRS Score)Endovascular Group Outcome (mRS Score)P
    0, 1, 23, 4, 5, 60, 1, 23, 4, 5, 6
    Hunt Hess
        All subjects67.4%32.6%78.9%21.1%.034a
        HH ≤370.0%30.0%84.9%15.1%.006a
        HH ≥459.1%40.9%40.7%59.3%.251
    Fisher
        All subjects67%33%77.8%22.2%.054a
        Fisher 1–277.1%22.9%88.8%11.2%.081
        Fisher 3–461.4%38.6%61.1%38.9%.973
    • ↵a Significant.

    • View popup
    Table 3:

    Multivariable binary logistic analysis to evaluate variables predictive of clinical outcome

    Variableβ ± SEP ValueOR (95% CI)
    Treatment (surgery/endovascular)−0.20 ± 0,31.5160.82 (0.45–1.49)
    Sex (female/male)−0.07 ± 0.35.8401.02 (0.99–1.05)
    Age (yr)0.02 ± 0.01.1970.93 (0.47–1.85)
    Fisher grade0.44 ± 0.20.031a1.55 (1.04–2.30)
    HH grade0.38 ± 0.19.041a1.47 (1.02–2.12)
    • Note:—SE indicates standard error.

    • ↵a Significant.

    • View popup
    Table 4:

    Clinical outcome of patients treated with endovascular techniques

    Outcome (mRS Score) (P = .266)Total(%)
    0, 1, 23, 4, 5, 6
    (No.)(%)(No.)(%)
    Balloon-assisted coils675.0225.084
    Coil952.9847.1179
    Coil + stent, no FD4171.91628.15729
    FD3782.2a817.8a4523
    FD + coils3100.000.032
    FD + stent1100.000.011
    Multistent2100.000.021
    PAO888.9111.195
    SAC2385.2a414.8a2714
    SAC + FD1100.000.011
    Stent1986.4a313.6a2211
    Stent in stent3100.000.032
    Trapping with coil4100.000.042
    Total15742199104
    • Note:—FD indicates flow diverter; PAO, parent artery occlusion; SAC, stent-assisted coiling,

    • ↵a Results for the largest groups.

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    Table 5:

    Clinical outcome of patients treated with surgical techniques

    Outcome (mRS Score) (P = .12)Total(%)
    0, 1, 23, 4, 5, 6
    (No.)(%)(No.)(%)
    Bypass1100.000.010.9
    Clip466.7233.365.3
    Clip + arteriotomy2668.4a1231.6a3833.6
    Clip + bypass3100.000.032.7
    PAO00.01100.010.9
    Proximal ligation + RA bypass00.01100.010.9
    Sutured266.7133.332.7
    Trapping222.2777.898.0
    Trapping + RA bypass1292.3a17.7a1311.5
    Wrapping + bypass + PAO1100.000.010.9
    Wrapping + clip2982.9a617.1a3531.0
    Wrapping150.0150.021.8
    Total8132113100
    • Note:—RA indicates radial artery; PAO, parent artery occlusion.

    • ↵a Results for the largest groups.

    • View popup
    Table 6:

    Characteristics of blister-like aneurysms

    CharacteristicDescription
    LocalizationNonbranching site, proximal
    DimensionSmall, <3 mm (within 24 hours of SAH)
    ShapeConical, wide-neck
    AppearanceDissecting
    Tendency to rebleedHigh, due to friable walls
    Tendency to growHigh
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American Journal of Neuroradiology: 37 (5)
American Journal of Neuroradiology
Vol. 37, Issue 5
1 May 2016
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Cite this article
S. Peschillo, D. Cannizzaro, A. Caporlingua, P. Missori
A Systematic Review and Meta-Analysis of Treatment and Outcome of Blister-Like Aneurysms
American Journal of Neuroradiology May 2016, 37 (5) 856-861; DOI: 10.3174/ajnr.A4606

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A Systematic Review and Meta-Analysis of Treatment and Outcome of Blister-Like Aneurysms
S. Peschillo, D. Cannizzaro, A. Caporlingua, P. Missori
American Journal of Neuroradiology May 2016, 37 (5) 856-861; DOI: 10.3174/ajnr.A4606
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  • Interventions to treat patients with blood blister-like aneurysms of the internal carotid artery: a protocol for a network meta-analysis
  • Endovascular Treatment of Ruptured Intracranial Blister Aneurysms: A Systematic Review and Meta-analysis
  • Treatment of Ruptured Blister-Like Aneurysms with the FRED Flow Diverter: A Multicenter Experience
  • Integrative Analysis of 334 Patients with Blister-Like Aneurysms
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