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Stent-assisted Coiling vs. Flow Diverter for Treating Blood Blister-like Aneurysms

A Proportion Meta-analysis

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Abstract

Purpose

Blood blister-like aneurysms (BBAs) are rare vascular lesions and a therapeutic challenge. Although endovascular treatment of BBA is a promising approach, the optimal treatment remains controversial. The purpose of this study was to compare the safety and efficacy of stent-assisted coiling (SAC) and flow diverter (FD) in the management of BBAs.

Methods

A proportion meta-analysis including a published series of BBAs treated with endovascular approaches from 2009 to 2020 including SAC and FD was performed by searching English language studies via MEDLINE and EMBASE.

Results

The 32 studies included 16 based on SAC and 16 involving FD. The long-term complete occlusion rate was higher in FD (89.26%, 95% confidence interval, CI 82.93–94.26%, I2 = 14.42%) than in SAC (70.26%, 95% CI 56.79–82.13%, I2 = 70.60%). The rate of aneurysm recanalization was lower in FD (4.54%, 95% CI 1.72–8.16%, I2 = 0%) than in SAC (25.38%, 95% CI 14.44–38.19%, I2 = 67.31%). Rates of mortality, favorable functional outcome, procedural complications, and rebleeding showed no differences between the two procedures.

Conclusion

In a proportion meta-analysis comparing FD with SAC, the FD was associated with more favorable angiographic outcomes but similar complications and clinical outcomes.

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Authors and Affiliations

  1. Department of Neurosurgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, 27th-gil, Dongguk-ro, Ilsandong-gu, 410-773, Goyang-si, Gyeonggi-do, Korea (Republic of)

    Jeongjun Lee, Su Hwan Lee, Jung Hyeon Moon, Seung-Yeob Yang & Keun-Tae Cho

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, 27th-gil, Dongguk-ro, Ilsandong-gu, 410-773, Goyang-si, Gyeonggi-do, Korea (Republic of)

    Do Hyung Kim & Bo Hae Kim

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Correspondence to Keun-Tae Cho or Bo Hae Kim.

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Conflict of interest

J. Lee, D. H. Kim, S. H. Lee, J. H. Moon, S.-Y. Yang, K.-T. Cho and B. H. Kim, declare that they have no competing interests.

Additional information

B. H. Kim and K.-T. Cho contributed equally to this report as corresponding authors.

Supplementary Information

Supplementary Fig. 1

The rates of procedural complications in SAC and FD based on the proportion meta-analysis involving 24 studies [3, 18,19,20, 22, 26, 27, 29,30,31,32,33, 35,36,37,38,39,40,41, 43,44,45, 47, 48]. SAC stent-assisted coiling, No number, CI confidence interval, FD flow diverter.

Supplementary Fig. 2

Rebleeding rates associated with SAC and FD in the proportion meta-analysis involving 27 studies [3, 18, 19, 21,22,23,24, 26,27,28,29,30,31,32,33,34, 36,37,38,39,40,41, 43,44,45, 47, 48]. SAC stent-assisted coiling, No number, CI confidence interval, FD flow diverter.

Supplementary Fig. 3

Funnel plots for estimates in the proportion meta-analysis involving blood-blister like aneurysms treated with SAC or FD according to complete occlusion rate at follow-up. In the funnel plot, the X‑axis represent the mean results and the Y-axis shows the sample size. SAC stent-assisted coiling, FD flow diverter.

Supplementary Fig. 4

Funnel plots for estimates in the proportion meta-analysis involving blood-blister like aneurysms treated with SAC or FD according to recanalization rate. In the funnel plot, the X‑axis represent the mean results and the Y-axis shows the sample size. SAC stent-assisted coiling, FD flow diverter

Supplementary Fig. 5

Funnel plots for estimates in the proportion meta-analysis involving blood-blister like aneurysms treated with SAC or FD according to mortality rate. In the funnel plot, the X‑axis represent the mean results and the Y-axis shows the sample size. SAC stent-assisted coiling, FD flow diverter

Supplementary Fig. 6

Funnel plots for estimates in the proportion meta-analysis involving blood-blister like aneurysms treated with SAC or FD according to rate of favorable outcome. In the funnel plot, the X‑axis represent the mean results and the Y-axis shows the sample size. SAC stent-assisted coiling, FD flow diverter

Supplementary Fig. 7

Funnel plots for estimates in the proportion meta-analysis involving blood-blister like aneurysms treated with SAC or FD according to rate of procedural complication. In the funnel plot, the X‑axis represent the mean results and the Y-axis shows the sample size. SAC stent-assisted coiling, FD flow diverter

Supplementary Fig. 8

Funnel plots for estimates in the proportion meta-analysis involving blood-blister like aneurysms treated with SAC or FD according to rebleeding rate. In the funnel plot, the X‑axis represent the mean results and the Y-axis shows the sample size. SAC stent-assisted coiling, FD flow diverter

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Lee, J., Kim, D.H., Lee, S.H. et al. Stent-assisted Coiling vs. Flow Diverter for Treating Blood Blister-like Aneurysms. Clin Neuroradiol 32, 889–902 (2022). https://doi.org/10.1007/s00062-022-01160-3

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