Stent-assisted Coiling vs. Flow Diverter for Treating Blood Blister-like Aneurysms: A Proportion Meta-analysis

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.