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Towards a new treatment paradigm for ruptured blood blister-like aneurysms of the internal carotid artery? A rapid systematic review
  1. Tomasz Szmuda1,
  2. Pawel Sloniewski1,
  3. Przemyslaw M Waszak2,
  4. Janusz Springer3,
  5. Marta Szmuda4
  1. 1Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland
  2. 2Students Scientific Association at Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland
  3. 3Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
  4. 4Developmental Neurology, Medical University of Gdansk, Gdansk, Poland
  1. Correspondence to Dr Tomasz Szmuda, Neurosurgery Department, Medical University of Gdansk, Poland. Address: Debinki 7, Gdansk 81-952, Poland; tszmuda{at}gumed.edu.pl

Abstract

Background and purpose Owing to their peculiar features and rare occurrence, ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery are challenging by both surgical and endovascular approaches and their proper management is uncertain. We therefore aimed to define the currently optimal treatment of ruptured BBAs in terms of mortality, outcome, rebleeding, and recurrence.

Method An in-depth search of electronic databases, gray literature and internet resources for ruptured BBAs was performed and complemented by data retrieval during neurosurgical congresses. Clinical and radiological characteristics, intervention details, outcomes, and the impact factor of the source journal were pooled.

Results The pooled cohort comprised 311 patients. Neither surgical nor endovascular methods had an impact on clinical outcome, aneurysm regrowth, remote bleeding, or complication rate. By contrast, aneurysm clipping was a predictor of intraoperative bleeding (OR 6.5; 95% CI 1.2 to 34.3), and stent-assisted coiling increased the likelihood of a second treatment (OR 4.1; 95% CI 1.3 to 13.1), its conversion to another modality (OR 4.7; 95% CI 1.4 to 16.0), and incomplete aneurysm obliteration (OR 2.6; 95% CI 1.0 to 6.6). Higher impact journals were more likely to publish papers on endovascular techniques, particularly flow-diverter stents.

Conclusions None of the methods is unequivocally superior. Considering its inefficiency, stent-assisted coiling should be undertaken with caution. A time-delimited systematic review is needed to establish the most accurate treatment for ruptured BBAs.

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