J Neurosurg. 2017 Dec;127(6):1361-1373. doi: 10.3171/2016.9.JNS161526. Epub 2017 Feb 17.
OBJECTIVE Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) have a poor natural history associated with high morbidity and mortality. Currently, both surgical and endovascular techniques are employed to treat BBAs; thus, the authors sought to perform a meta-analysis to compare the efficacy and safety of these approaches. METHODS A literature search of PubMed, MEDLINE, and Google Scholar online databases was performed to include pertinent English-language studies from 2005 to 2015 that discussed the efficacy and safety of either surgical or endovascular therapies to treat BBAs. RESULTS Thirty-six papers describing 256 patients with BBAs treated endovascularly (122 procedures) or surgically (139 procedures) were examined for data related to therapeutic efficacy and safety. Pooled analysis of 9 papers demonstrated immediate and late (mean 20.9 months) aneurysm occlusion rates of 88.9% (95% CI 77.6%-94.8%) and 88.4% (95% CI 76.7%-94.6%), respectively, in surgically treated patients. Pooled analysis of 12 papers revealed immediate and late aneurysm obliteration rates of 63.9% (95% CI 52.3%-74.1%) and 75.9% (95% CI 65.9%-83.7%), respectively, in endovascularly treated aneurysms. Procedure-related complications and overall poor neurological outcomes were slightly greater in the surgically treated cases than in the endovascularly treated cases (27.8% [95% CI 19.6%-37.8%] vs 26.2% [95% CI 18.4%-35.8%]), indicating that endovascular therapy may provide better outcomes. CONCLUSIONS Blood-blister aneurysms are rare, challenging lesions with a poor prognosis. Although surgical management potentially offers superior aneurysm obliteration rates immediately after treatment and at the long-term follow-up, endovascular therapy may have a better safety profile and provide better functional outcomes than surgery. A registry of patients treated for BBAs may be warranted to better document the natural course of the disease as well as treatment outcomes.
颈内动脉（ICA）的血泡样动脉瘤（BBAs）具有较差的自然病史，与高发病率和死亡率相关。目前，手术和血管内技术都被用于治疗 BBA；因此，作者旨在进行一项荟萃分析，以比较这些方法的疗效和安全性。
对 PubMed、MEDLINE 和 Google Scholar 在线数据库进行文献检索，纳入 2005 年至 2015 年期间讨论手术或血管内治疗 BBA 的疗效和安全性的相关英文研究。
对 36 篇描述了 256 例接受血管内（122 例）或手术（139 例）治疗的 BBA 患者的论文进行了数据评估，以评估治疗效果和安全性。9 篇论文的汇总分析显示，手术治疗患者的即刻和晚期（平均 20.9 个月）动脉瘤闭塞率分别为 88.9%（95%可信区间 77.6%-94.8%）和 88.4%（95%可信区间 76.7%-94.6%）。12 篇论文的汇总分析显示，血管内治疗的即刻和晚期动脉瘤闭塞率分别为 63.9%（95%可信区间 52.3%-74.1%）和 75.9%（95%可信区间 65.9%-83.7%）。手术治疗病例的与手术相关的并发症和整体不良神经预后略高于血管内治疗病例（27.8%[95%可信区间 19.6%-37.8%]比 26.2%[95%可信区间 18.4%-35.8%]），表明血管内治疗可能提供更好的结果。
血泡样动脉瘤是罕见的、具有挑战性的病变，预后较差。虽然手术治疗可能在治疗后即刻和长期随访中提供更好的动脉瘤闭塞率，但血管内治疗可能具有更好的安全性，并提供比手术更好的功能结果。可能需要建立一个治疗 BBA 的患者登记处，以更好地记录疾病的自然病程和治疗结果。
