Efficacy of flow diversion in blister-like intracranial aneurysms during acute subarachnoid hemorrhage: a single-arm meta-analysis
Bibliographic record
Abstract
BACKGROUND: Blister-like intracranial aneurysms are rare fragile lesions with a high risk of rupture leading to acute subarachnoid hemorrhage (aSAH) and significant morbidity. Flow diversion (FD) has emerged as a promising endovascular treatment, particularly for complex cases unsuitable for clipping or coiling, but evidence in ruptured settings remains limited due to challenges such as the risks of dual antiplatelet therapy. This study aimed to evaluate the efficacy and safety of FD in ruptured blister-like aneurysms during aSAH through a systematic review and meta-analysis. METHODS: A single-arm meta-analysis was conducted following PRISMA guidelines, searching Medline, Web of Science, Embase, and Cochrane Library from inception to the present. Inclusion criteria were patients of any age with acutely ruptured blister-like aneurysms treated with FD, focusing on occlusion rates, complications, rebleeding, retreatment, modified Rankin Scale (mRS) scores, and mortality. Data were analyzed using a random effects model, with heterogeneity assessed by I² and quality evaluated using the Newcastle-Ottawa Scale. RESULTS: Twenty observational studies (n=209 patients) were included. The mean age was 50.7 years and 60.7% were women. Follow-up occlusion reached 83% (95% CI 0.72 to 0.94; I²=86%), while immediate occlusion was 37% (95% CI 0.18 to 0.55; I²=92%). Functional outcomes showed 91% had an mRS score of 0-2 at follow-up (95% CI 0.86 to 0.96; I²=0%) and 64% at discharge (95% CI 0.32 to 0.96; I²=96%). Complications were 9% intraprocedural (95% CI 0.04 to 0.15; I²=36%) and 6% postprocedural (95% CI 0.01 to 0.11; I²=0%), with rebleeding at 2% (95% CI 0.00 to 0.06; I²=0%) and mortality at 2% (95% CI 0.00 to 0.06; I²=0%). Sensitivity and publication bias analyses confirmed the stability of the results. CONCLUSIONS: FD achieves high occlusion and favorable functional outcomes in ruptured blister-like aneurysms, although immediate occlusion and complications pose challenges. Future research should optimize antiplatelet strategies and standardize protocols.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.023 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.061 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".