Introduction Even in the era of modern neurosurgery and endovascular treatment, managing a ruptured blood-blister aneurysm of the internal carotid artery (ICA-BBA) remains a formidable challenge.

Aim of Study In this systematic review and meta-analysis, our objective is to compare the efficacy and safety of two approaches.

Methods A systematic search was conducted on outcomes of surgical versus endovascular repair of ICA-BBAs, utilizing PubMed, Scopus, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Comparisons were based on complete occlusion, recurrence, final favorable mRS (0-2), and complications. The comparison between the two approaches was conducted using a weighted random-effects model.

Results A total of 6 studies and 428 cases with ICA-BBAs (261 microsurgical, and 167 endovascular repair) were included. While the rates of complete occlusion (OR: 0.92, 95%CI: 0.26-3.24, p-value=0.9, I²:0.0%), recurrence (OR: 1.05, 95%CI: 0.30-3.68, p-value=0.94, I²:0.0%), and favorable mRS score (OR: 2.19, 95%CI: 0.76-6.26, p-value=0.14, I²:65.31%) did not significantly differ between the two groups, endovascular repair was associated with significantly lower rates of intraoperative bleeding (OR: 0.06, 95%CI: 0.02-0.20, p-value <0.0001, I²: 0.0%) and infarction (OR: 0.19, 95%CI: 0.09-0.40, p-value <0.0001, I²: 0.0%). We did not find a significant difference in postoperative vasospasm between the two groups (OR: 0.64, 95%CI: 0.22-1.88, p-value =0.42, I²: 36.83%).

Conclusion Our literature review revealed comparable success rates between the two treatment approaches. Nevertheless, endovascular treatment demonstrates superior outcomes when considering complications. Future comparative studies incorporating advancements in endovascular technologies are warranted to establish the optimal treatment option.

Disclosure of Interest no.