Endovascular Patch Embolization for Blood Blister–Like Aneurysms in Dorsal Segment of Internal Carotid Artery

Hao, Xudong; Li, Guilin; Ren, Jian; Li, Jingwei; He, Chuan; Zhang, Hongqi

doi:10.1016/j.wneu.2018.01.014

Cited by 17 publications

(8 citation statements)

References 26 publications

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“…In our center, we also adopted the technique of “endovascular patch embolization” to repair the fragile neck, which is one of the challenges in BBA therapy ( 40 ). The advantage of this technique is that embolization of the aneurysm neck can be achieved using coils and staged-deployed PED.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Liu

Zhang

et al. 2022

Front. Neurol.

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BackgroundBlood blister aneurysm (BBA) is a complex and rare aneurysm that presents significant treatment challenges. The application of pipeline embolization device (PED)-assisted coiling in the treatment of ruptured BBA remains controversial. This study aimed to report on our experience and assess the safety and efficacy of this strategy.MethodsBetween February 2019 and February 2021, 12 patients with ruptured BBAs underwent PED-assisted coil embolization. We collected detailed data about each patient, including demographic information, aneurysmal data, technical details, antiplatelet strategy, operation-related complications, and follow-up outcomes.ResultsA total of 12 BBA patients were treated with single PED-assisted coil embolization. One patient experienced intraoperative rupture that was controlled by rapid coiling without clinical consequences. All the patients demonstrated complete occlusion on postoperative angiography. A total of three patients had postoperative complications: left hemiparesis, Broca's aphasia, and right hemiplegia due to vasospasm, and transient hemiparesis. Follow-up angiography revealed that all BBAs were completely occluded, except one with neck residue. All patients had favorable outcomes at discharge and the most recent clinical follow-up (mRS score ≤ 2).ConclusionEndovascular treatment of BBAs of the internal carotid artery using PED-assisted coil embolization is a safe and effective strategy. This has contributed to the understanding of BBA therapy and provides a potentially optimal treatment option for this intractable lesion.

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Section: Discussionmentioning

confidence: 99%

Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Liu

Zhang

et al. 2022

Front. Neurol.

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“…Endovascular reconstructive treatment with multiple stents has had relatively good results [4][5][6]8,13,19) . Nevertheless, frequent recurrences and rebleeding of the treated aneurysm are still major drawbacks of endovascular reconstruction 3,13,16) .…”

Section: Discussionmentioning

confidence: 99%

Is Stent-Assisted Coil Embolization for the Treatment of Ruptured Blood Blister-Like Aneurysms of the Supraclinoid Internal Carotid Artery Effective? : An Analysis of Single Institutional Experience with Pooled Data

Roh

Kim

Suh

et al. 2021

J Korean Neurosurg Soc

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Objective : Given the high risk of rebleeding and recurrence of blood blister-like aneurysms (BBAs), we treated ruptured BBAs of the internal carotid artery (ICA) with stent-assisted coil embolization (SAC). This study aimed to evaluate the efficacy and safety of SACs. Methods : We retrospectively reviewed clinical and radiological data from eight patients with ruptured BBAs of the supraclinoid ICA. The modified Rankin Scale (mRS) was used to assess clinical outcomes, while radiological outcomes were evaluated on angiographs. For a pooled analysis, data from literature reporting the outcomes of ruptured BBAs treated with SAC were collected and analyzed in conjunction with our data. Results : In our cohort, the mean Raymond classification score was 1.57±0.53 immediately after initial endovascular treatment. There were no perioperative complications or rebleeding events during the follow-up period. The mean mRS score at patient discharge was 1.00±0.81 and improved to 0.28±0.48 by the last follow-up day. The recurrence rate was 25% with an asymptomatic presentation and successful treatment with multiple stent insertion. Pooled analysis of 76 cases of SAC revealed a complete occlusion rate immediately after treatment of 54.8%, rebleeding rate 7.94%, and recurrence rate 24.2%. Good clinical outcomes with mRS score 0-2 were observed in 89.9% by the last clinical follow-up. Total mortality rate was 7.7%. Conclusion : This treatment appears to not only minimize the hemodynamic burden on the fragile dome specific to this type of aneurysm, but also provides an opportunity for safe and effective treatment in recurrent cases.

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“…Blood blister-like aneurysms (BBAs) usually appear at the anteromedial or anterior wall of the supraclinoid segment of the internal carotid artery (ICA) [1][2][3][4]. Although BBAs are rare, comprising approximately 0.3% to 1.0% of intracranial aneurysms (IAs), 0.5 to 2.0% of ruptured IAs and 0.9% to 6.5% of ICAs, their propensity to cause spontaneous subarachnoid hemorrhage (SAH) has led to high morbidity and mortality [5][6][7]. Many treatment strategies have been reported in the literature, but the management of BBAs has proven to be intractable, and the optimal therapeutic strategy for BBAs is still under debate [5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Although BBAs are rare, comprising approximately 0.3% to 1.0% of intracranial aneurysms (IAs), 0.5 to 2.0% of ruptured IAs and 0.9% to 6.5% of ICAs, their propensity to cause spontaneous subarachnoid hemorrhage (SAH) has led to high morbidity and mortality [5][6][7]. Many treatment strategies have been reported in the literature, but the management of BBAs has proven to be intractable, and the optimal therapeutic strategy for BBAs is still under debate [5][6][7][8][9][10][11][12]. The microsurgical treatments for BBAs include direct clipping, wrapping, wrap-clipping, trapping, and revascularization.…”

Section: Introductionmentioning

confidence: 99%

“…During the process of separating, exposing, or clipping the BBA, the aneurysm's neck is easily torn and can cause intraoperative bleeding, leading to a poor prognosis [13,15,16]. The tortuous supraclinoid portion of the ICA, the fragile aneurysm wall and the small size of the aneurysm result in a lack of stability and support, which are needed for microcatheter and coiling control during endovascular treatment [7,10,11,17].…”

Section: Introductionmentioning

confidence: 99%

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Current Knowledge of and Perspectives about the Pathogenesis of Blood Blister-like Aneurysms of the Internal Carotid Artery: A Review of the Literature

Zhai¹,

Hu²,

He³

et al. 2021

Int. J. Med. Sci.

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Blood blister-like aneurysms (BBAs) are rare and usually appear at nonbranching sites in the supraclinoid portion of the internal carotid artery (ICA). Because it is difficult to obtain histological specimens of the aneurysm wall and because experimental models are challenging to establish, the pathogenesis of BBAs remains uncertain. In this paper, we reviewed the diagnostic, radiological, and pathophysiological characteristics of patients with BBAs. We also summarized the existing evidence and potential mechanisms related to the causes of BBAs. Current evidence indicates that atherosclerosis and dissection are the main prerequisites for the formation of BBAs. Hemodynamics may play a role in the process of BBA formation due to the unique vascular anatomy of the supraclinoid ICA. Further research on histopathology and hemodynamics is warranted in this field.

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Endovascular Patch Embolization for Blood Blister–Like Aneurysms in Dorsal Segment of Internal Carotid Artery

Cited by 17 publications

References 26 publications

Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Is Stent-Assisted Coil Embolization for the Treatment of Ruptured Blood Blister-Like Aneurysms of the Supraclinoid Internal Carotid Artery Effective? : An Analysis of Single Institutional Experience with Pooled Data

Current Knowledge of and Perspectives about the Pathogenesis of Blood Blister-like Aneurysms of the Internal Carotid Artery: A Review of the Literature

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