Characteristics of Blood Blister-Like Aneurysms with a Saccular-Shape Appearance

Nishikawa, Hirofumi; Shimizu, Shigetoshi; Nakajima, Hideki; Kitano, Yasushi; Sano, Takanori; Mouri, Genshin; Miya, Fumitaka; Suzuki, Hitomi

doi:10.1016/j.wneu.2017.09.054

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…BBAs may be misdiagnosed as saccular aneurysms of the ophthalmic, anterior choroidal, or P-ComA arteries. 13 However, given that the hemorrhage was localized around the left basal cistern in this case and that the late subacute stage hemorrhage was confirmed on MRI, the irregular vessel appearance was more likely related to vasospasm than a BBA.…”

Section: Discussionmentioning

confidence: 63%

Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report

et al. 2021

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A 44-year-old woman presented with acute confusion, apparently due to a clinically silent subarachnoid hemorrhage followed by vasospasm, which in turn led to an ischemic stroke. During the initial evaluation, an acute ischemic stroke in the left middle cerebral artery territory was observed. Magnetic resonance imaging revealed a late subacute hemorrhage in the left basal cistern. Digital subtraction angiography indicated the presence of a small saccular aneurysm that had recently ruptured, as well as vasospasm in the left circle of Willis. Balloon angioplasty and balloon-assisted coil embolization were performed for the vasospasm and saccular aneurysm, respectively. This case demonstrates that clinically silent subarachnoid hemorrhages resulting in ipsilateral vasospasm and infarction can occur as complications of a ruptured aneurysm.

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Section: Discussionmentioning

confidence: 63%

Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report

et al. 2021

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“…[ 4 ] BBAs are a subtype with small size, fragile walls, and a poorly defined broad-based neck. [ 2 ] Despite poorly understood pathophysiology, current investigations suggest that BBAs primarily originate from dissections. [ 4 ] Their fragility is due to thinned adventitia overlying underlying defects in the intima and media, and there is a strong association between these aneurysms and arteriovenous malformations.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] BBAs are thin-walled vascular lesions with a poorly defined aneurysmal neck which – unlike traditional saccular aneurysms – and typically do not arise at arterial branching points. [ 2 ] Consequently, they provide a unique challenge for management, often requiring multiple treatments complicated with a high incidence of rebleeding, particularly in the posterior circulation. [ 1 ] We present two patients with ruptured BBAs who received endovascular treatment using the stent-in-stent approach.…”

Section: Introductionmentioning

confidence: 99%

Stent-in-stent technique for the management of blood blister-like basilar apex aneurysms

2021

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Blood blister-like basilar apex aneurysms are rare thin-walled vascular lesions with a poorly defined aneurysmal neck. We present two patients with ruptured blister aneurysms of the basilar apex who were treated using the stent-in-stent technique. Long-term follow-up showed persistent and complete occlusion of the aneurysms without radiographically or neurological complications. There is no optimal treatment of choice for the basilar apex blood blister-like aneurysms. Double- or triple-stent placement using the stent-in-stent technique can be a safe and feasible option for these uncommon and challenging intracranial aneurysms.

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“…In some cases, they even have a lobular component, which can cause diagnostic confusion (Figures 5 and 6). 21 In these cases, they resemble multilobulated dissecting aneurysms (compare Figure 4 with Figure 7). • Unlike regular saccular aneurysms, both types of these non-saccular aneurysms are localised on the non-branching segment of an artery.…”

Section: Importance Of Classification Of Non-saccular Aneurysmsmentioning

confidence: 93%

Endovascular treatment of type 1 and type 4 non-saccular aneurysms of cerebral arteries – a single-Centre experience

et al. 2021

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Aim of the study The aim of this study was to evaluate our results regarding treatment options, complications, and outcomes in patients with non-saccular aneurysms of cerebral arteries belonging to type 1 and type 4 according to Mizutani’s classification. Methods A total of 26 aneurysms in 26 patients were treated between 2014 and 2019. There were 13 males (mean age 42.77 ± 11.73 years) and 13 females (mean age 50.84 ± 9.37 years). In 23 cases the onset was haemorrhagic and in three cases non-haemorrhagic. A combination of conventional stents and coils was used in 10 cases, conventional stents and flow diverters in three cases, flow diverters and coils in five cases, and flow diverters only were used in eight cases. Radiological results of treatment were assessed after eight months and clinical after one year. Results In 24 patients, aneurysms were occluded at the end of the follow-up period. An iatrogenic dissection and two haemorrhagic complications were registered. In three cases, parent arteries were occluded due to re-growth of the aneurysm, which caused middle cerebral artery infarction in one case. A favourable clinical outcome was registered in 19, patients, and non-favourable in five. Two patients died in the early postoperative period due to extensive damage to the brain parenchyma caused by initial bleeding. Conclusion Our results indicate that treatment of type 1 and type 4 non-saccular aneurysms with various combination of stents and flow diverters, with or without coils, is promising, although very challenging and technically demanding.

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Characteristics of Blood Blister-Like Aneurysms with a Saccular-Shape Appearance

Cited by 20 publications

References 23 publications

Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report

Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report

Stent-in-stent technique for the management of blood blister-like basilar apex aneurysms

Endovascular treatment of type 1 and type 4 non-saccular aneurysms of cerebral arteries – a single-Centre experience

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