Background and purpose Various endovascular techniques have been applied to treat Blister-Like Aneurysms (BLA). We performed a systematic review to evaluate endovascular treatment for ruptured BLAs.

Materials and methods We performed a comprehensive literature search and subgroup analyzes to compare deconstructive versus reconstructive techniques and flow diversion versus other reconstructive options.

Results 31 studies with 265 procedures for ruptured BLA were included. Endovascular treatment was associated with a 72.8% (95% CI = 64.2–81.5) long-term occlusion rate and a 19.3% (95% CI = 13.6–25.1) retreatment rate. Long-term neurological outcome was good in 76.2% (95% CI = 68.9–8.4) of patients. 240 procedures (90.6%) were reconstructive techniques (coiling, stent-assisted coiling, overlapped stenting, flow diversion) and 25 treatments (9.4%) were deconstructive. Deconstructive techniques had higher rates of initial complete occlusion than reconstructive techniques (77.3% vs. 33.0%, P = 0.0003) but a higher risk for perioperative stroke (29.1% vs. 5.0%, P = 0.04). There was no difference in good long-term neurological outcome between groups with 76.0% for the reconstructive group versus 82.8% for the deconstructive group (P = 0.27). Of 240 reconstructive procedures, 62 (25.8%) involved flow-diverter stents, with higher rates of long-term complete occlusion than other reconstructive techniques (90.8% vs. 67.9%, P = 0.03) and a lower rate of retreatment (6.6% vs. 30.7%, P < 0.0001).

Conclusions Endovascular treatment of ruptured BLAs is associated with high rates of complete occlusion and good long-term neurological outcomes in most patients. Deconstructive techniques are associated with higher occlusion rates, but higher risk of peri-operative ischemic stroke. In the reconstructive group, flow diversion carries higher level of complete occlusion and similar clinical outcomes.

Disclosures A. Rouchaud: None. W. Brinjikji: None. H. Cloft: None. D. Kallmes: None.