Clipping on Crossed Wrapping Method for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: Technical Note and Long-Term Results

Abstract

Background We have been performing the clipping on crossed wrapping (COCW) method using 2 strips of cotton on patients with an internal carotid artery blood blister-like aneurysm (IC-BLA). This method is reliable in preventing the clips from slipping off and the aneurysm walls from being damaged during clipping, and it enables more appropriate and safer clipping. Here we report the technical details of this method and the long-term outcomes of patients receiving this procedure. Methods Fifteen of 1275 (1.5%) patients with a ruptured cerebral aneurysm who received treatment at the Saiseikai Kumamoto Hospital during the period from January 1, 1999, to December 31, 2016, had an IC-BLA. All 15 patients were treated with COCW, except for the first patient, who was treated using a single strip of cotton. The long-term outcome of the treatment was analyzed. Results The mean follow-up period was 74 months. The first patient experienced rerupture of an aneurysm 10 days after the operation. No complications or regrowth of an aneurysm were observed in the remaining 14 patients during the follow-up period, except for 1 patient who received a reoperation for the regrowth of an aneurysm. As the final outcome, the numbers of patients with a Modified Rankin Score of 0, 3, and 6 were 13, 1, and 1, respectively. Conclusions It is suggested that COCW is a treatment that enables safe and long-term management of lesions in IC-BLAs.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience

“…Both treatments for BBAs are still greatly challenging for neurosurgeons and neuroradiologists due to the special features of BBAs. Currently, the main treatment options for BBAs include surgical clipping, artery suturing, wrapping and clipping, stent-assisted coiling embolization, multi-stent implantation, and flow-diverting stents ( 2 , 6 , 14 – 17 ). However, a rescue or second treatment was required in 21% patients, and the overall morbidity and mortality rates were 17 and 15%, respectively.…”

Stent-Assisted Coil Embolization of Ruptured Blood Blister-Like Aneurysm of the Basilar Artery: A Case Report and Literature Review

“…According to previous studies, the incidences of additional hemorrhage and enlargement after craniotomy are approximately 30% and 4%, respectively, and those after endovascular treatment are approximately 11% and 34%, respectively. [2][3][4][5][6]10) A previous study reported the clippingon-crossed-wrapping method for BBA of the internal carotid artery 11) This method requires circumferential exfoliation, but it is difficult to operate on the deep area of the basilar artery; safe exfoliation at the aneurysmal periphery, which is fragile, is highly difficult. Postoperative recurrence/rebleeding has been reported.…”

Safety and Efficacy of Endovascular Therapy for Blood Blister-Like Aneurysms: Willis Covered Stents and Double Stents Assistant Coils—A Single Center Cohort Study

“…Owing to the lack of collagen and internal elastic membranes and because of the need to administer antiplatelet and anticoagulant therapy, the perioperative rebleeding rate was higher than in other types of aneurysms, irrespective of the method performed. Even in experienced centers, intraoperative rupture rates in BBAs have been reported to be up to 50% compared with the rate of 7% seen with saccular aneurysms (7). Compared with WCSs, double stent-assisted coils have the possibility of puncturing the aneurysm during the treatment procedure.…”

“…Compared with endovascular methods, microsurgery can provide a higher occlusion rate. However, the disadvantages of microsurgery include the higher rate of complications and neurologic impairments (6)(7)(8). Technological improvements in intervention devices have led to improved safety and recovery rates associated with endovascular methods (5).…”