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A propensity score–matched study on the short-term outcome of ruptured blood blister-like aneurysm treated by microsurgery or endovascular surgery: a single-center study of 155 cases

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Abstract

Treating blood blister-like aneurysms (BBA) is a major neurosurgical challenge. Whether endovascular repair serves as a better strategy than microsurgery remains controversial. We aim to perform a propensity score–matched (PSM) retrospective study to analyze the short-term outcome in BBA patients who received microsurgery and endovascular treatment. One hundred fifty-five eligible patients with internal carotid artery BBA were retrospectively collected with demographic and angiographic baseline in a single center. Three-month outcome and adverse events were set as outcome endpoints. PSM was used to match the microsurgery and endovascular group. Matching effect was evaluated by distribution variation analysis and love plot. The outcome of neurosurgery and endovascular treatment was then compared before and after PSM. Better WFNS levels (p = .017) and modified Fisher grade (p = .027) were noted in endovascular group before matching. Other baseline including angiographic features were comparable between two groups. Before matching, the 3-month outcome of endovascular repair surgery was more favorable than microsurgery (p < .0001). The occurrence of adverse events was also higher in the microsurgery group (p = .0079). In PSM-adjusted groups, the superior outcome effect of endovascular treatment still existed but with a reduced significance (p = .004). Similar trend was also observed in the adverse event rate (p = .038). Fatality rate was comparable between two adjusted groups regardless of PSM adjustment. Endovascular surgery of BBAs exhibits overall more favorable short-term outcome regardless of PSM matching. Microsurgery does not cause a higher fatality rate, hence it could be considered a salvage plan for those high-grade BBA patients.

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Data availability

The clinical data used in this study can be provided via the corresponding authors upon reasonable request.

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Acknowledgements

We gratefully acknowledge the families and patients that voluntarily participate in this current study. Many thanks to the support received from the West China Hospital, Sichuan University.

Funding

Dr. Lu Ma received financial support in the form of National key R&D Program of China (No. 2018YFA0108604; No. 2018YFA0108603) and Clinical Incubation Program of West China Hospital, SCU (2018HXFU008). Dr. Zheng Jun received financial support from Sichuan Science and Technology Program (2020YFQ0009). Dr. Wei Fu was supported by the National Natural Science Foundation of China (82101550). The sponsors had no role in the design or conduct of this research.

Author information

Author notes

  1. Changwei Zhang and Lu Ma contributed equally and share senior authorship.

  2. Dingke Wen and Xing Wang contributed equally and shared first authorship.

Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Dingke Wen, Xing Wang, Ruiqi Chen, Hao Li, Jun Zheng, Wei Fu, Xiaodong Xie, Chao You, Changwei Zhang & Lu Ma

  2. Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, University of Electronic and Science Technology of China, Chengdu, China

    Duanya Liu

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  1. Dingke Wen
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Contributions

Dingke Wen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data Xing Wang: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Hao Li: Major role in the acquisition of data Ruiqi Chen: Major role in the acquisition of data Jun Zheng: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Fu Wei: Major role in the acquisition of data and analysis of data Duanya Liu: Analysis of the data and drafting the manuscript. Xiaodong Xie: Major role in the acquisition of endovascular treatment patient data; Study concept or design Chao You: Major role in the acquisition of microsurgery treated patient data; Changwei Zhang: Major role in the acquisition of endovascular treatment patient data; Study concept or design Lu Ma: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design; Analysis or interpretation of data

Corresponding authors

Correspondence to Changwei Zhang or Lu Ma.

Ethics declarations

Ethical approval and consent to participate

This study was approved by the institutional review board (West China Hospital Ethics Committee), under ethic approval number 2022–616. It was conducted using retrospective information and by the declaration of Helsinki; no identifiable information of the patients was disclosed. Consent to participate were uniformly obtained at admission and were archived in the charts system.

Human and animal ethics

This study was approved by the institutional review board (West China Hospital Ethics Committee), under ethic approval number 2022–616. It was adhesive to the STROBE checklist. Animal ethics is not applicable.

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All the authors have agreed to publish this article, and this article in part and whole has not been considered for publication elsewhere.

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The authors declare no competing interests.

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Wen, D., Wang, X., Chen, R. et al. A propensity score–matched study on the short-term outcome of ruptured blood blister-like aneurysm treated by microsurgery or endovascular surgery: a single-center study of 155 cases. Neurosurg Rev 45, 3789–3800 (2022). https://doi.org/10.1007/s10143-022-01887-0

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