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Title: Contemporary Treatment of Intracranial Blood Blister Aneurysms - A Systematic Review.
Austin Authors: Nasra, Mohamed;Mitreski, Goran;Kok, Hong Kuan;Maingard, Julian;Slater, Lee-Ann;Russell, Jeremy H ;Hall, Jonathan;Chong, Winston;Jhamb, Ashu;Brooks, Duncan Mark ;Asadi, Hamed 
Affiliation: Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
School of Medicine, Monash University, Clayton, Victoria, Australia
Melbourne School of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
Interventional Radiology Service, Northern Hospital, Epping, Victoria, Australia
Issue Date: Sep-2021
Date: 2021-07-13
Publication information: Journal of Stroke and Cerebrovascular Diseases 2021; 30(9): 105968
Abstract: Blood blister aneurysms (BBAs) are rare aneurysms affecting non-branched points of intracerebral arteries. Due to their small size and fragility, BBAs are prone to rupture, and can be challenging to diagnose and treat. Several treatment options have been suggested yet there is no consensus regarding the best modality to reduce morbidity and mortality. A systematic review of the literature was conducted searching for articles discussing the treatment of BBAs. Inclusion criteria included: articles published between January 2010 and August 2020, English language, with each paper including at least 15 patients. Studies included required detailed reporting of patient demographics, treatment, and patient outcomes (including complications, recurrence, neurologic functional status, and mortality). A total of 25 studies with 883 patients were included. Most were female (n = 594, 67.3%) and aneurysms were overwhelmingly located in the supraclinoid internal carotid artery (99%). Aneurysms were variable in size and mostly presented with subarachnoid haemorrhage. Endovascular treatment (n = 518, 58.7%) was more common than microsurgery (n = 365, 41.1%) while only 2 patients were managed conservatively. Complications were more common in patients treated microsurgically. Microsurgical procedures had an unfavorable outcome (mRS 4-6, GOS 1-3) rate of 27.8% (n = 100/360) while that of endovascular procedures was 14.7% (n = 70/477). Endovascular procedures had a lower mortality rate than microsurgical interventions (8.4% vs 11%). This review demonstrates that endovascular treatment of blood blister aneurysm has reduced morbidity and mortality when compared with microsurgical treatment. Small sample sizes and substantial study heterogeneity makes strong conclusions difficult.
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105968
Journal: Journal of Stroke and Cerebrovascular Diseases
PubMed URL: 34271273
Type: Journal Article
Subjects: Blood blister aneurysm
Flow diversion
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