Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister–Like Aneurysms

Meckel, Stephan; Singh, Tejinder; Undrén, Per; Ramgren, Birgitta; Nilsson, Ola; Phatouros, Constantine C.; McAuliffe, William; Cronqvist, M.

doi:10.3174/ajnr.a2392

Cited by 101 publications

(92 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, timing of the image acquisition may be another important factor for identifying the lesion, as BBAs tend to grow rapidly during a relatively short period of time. Furthermore, repeated DSA, including 3D rotational angiographic studies, is necessary to disclose the presence of BBAs, as they can be obscured by luminal irregularities related to atherosclerosis in adjacent arteries 11 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

Sung

et al. 2012

Interv Neuroradiol

View full text Add to dashboard Cite

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Seven, consecutive paconstructive endovascular treatment using a stent have been reported as effective for durable occlusion of a BBA [9][10][11] . The present study evaluated the clinical and angiographic outcomes in seven consecutive patients with BBAs who underwent reconstructive endovascular treatment.…”

Section: Patientsmentioning

confidence: 99%

The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

Sung

et al. 2012

Interv Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Two hundred milligrams of aspirin inhibit the platelet aggregation response within two hours 16,17 . The dose of clopidogrel eurysms, in combination with antiplatelet medicines [11][12][13][14] . The application of antiplatelet medicines preoperatively is not considered minor therapy for ruptured cerebral aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Not all cases were available for MRI study due to medical conditions; procedure-related ischemic lesion was determined by CT taken the day after coiling. anticoagulation management for stent-assisted coiling of ruptured cerebral aneurysm in the acute stage, and no thromboembolic complication occurred 13 . Development of useful new devices for intervention can change treatment strategies in terms of devices used conventionally and medications.…”

Section: Methodsmentioning

confidence: 99%

Safety of Preprocedural Antiplatelet Medication in Coil Embolization of Ruptured Cerebral Aneurysms at the Acute Stage

et al. 2014

View full text Add to dashboard Cite

Preoperative antiplatelet medication for aneurysm coil embolization during acute subarachnoid hemorrhage (SAH) is not common. However, recent advances in neurointerventional devices make antiplatelet medication necessary for SAH surgery. We tested the hypothesis that preprocedural antiplatelet therapy in the acute stage of SAH prevents complications due to ischemia or induced bleeding. We retrospectively reviewed 35 consecutive ruptured cerebral saccular aneurysms that underwent coiling at our institute. Two hundred milligrams of aspirin and 150 mg of clopidogrel were administered to the patients at least two hours before coiling. Systemic heparinization was given after sheath insertion. Procedure-related thrombus formation on digital subtraction angiography, and clinical evidence of ischemia and procedure-related stroke on CT were reviewed. The median patient age was 69 years. Five males and 30 females were included. Seventy-seven percent of patients were Hunt-Hess grades 1 to 3. Assist techniques were used in 20 cases (57%). We inserted one extracranial internal carotid artery stent, but no intracranial stent. Intraoperative thrombosis occurred in one case (2.9%), with no clinical symptoms. Postoperative cerebrospinal fluid drainage was done in three cases, but we experienced no bleeding complications. Preoperative antiplatelet therapy leads to a low rate of thromboembolic events in coiling during acute stage SAH, and this strategy had no adverse influence on bleeding complications.

show abstract

“…All aneurysms in our series and those we found in the literature could be readily classified into 1 of these 4 types (Table 2). 1,2,4,6,7,9,10,[12][13][14][18][19][20][23][24][25][26][27][28][29][31][32][33]35,[39][40][41][42][43][44]47,[49][50][51][52]57 Each type presented distinctive surgical pitfalls, which required a different clip placement technique.…”

Section: Blister Aneurysm Classificationmentioning

confidence: 99%

Morphological aspects of blister aneurysms and nuances for surgical treatment

Bojanowski

Weil

McLaughlin

et al. 2015

JNS

View full text Add to dashboard Cite

Blister aneurysms of the internal carotid artery (ICA) arise at a nonbranching site of the dorsal wall of the supraclinoid portion of the ICA. 1,17,30,31,36,38,45,48,53,54 These types of aneurysms are rare and their management remains difficult. Whether the approach to these aneurysms is surgical or endovascular, the literature shows a high mortality and morbidity rate due to their fragile wall with its high rate of rupture during treatment. 28,38,46,48 However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions, thus making different treatment strategies difficult to assess. The first goal of this study was to ascertain whether blister aneurysm morphology played a role in the different pitfalls that may be encountered during surgery, and whether this morphology would require adapted surgical strategies. The second goal was to investigate whether any morphological differences could be categorized into abbreviatioN ICA = internal carotid artery. obJect Blister aneurysms of the supraclinoid part of the internal carotid artery (ICA) are known for their high morbidity and mortality rates related to treatment, regardless of whether the treatment is surgical or endovascular. However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions. The goal of this study was 2-fold: to determine whether different blister aneurysm morphologies present different pitfalls, which would then require different surgical strategies, as well as to determine whether there are identifiable subgroups of these types of aneurysms based on morphology. methods The authors reviewed the charts, cerebral catheter angiograms, surgical reports, and intraoperative videos of all ICA blister aneurysms treated surgically at the Centre Hospitalier de l'Université de Montréal from 2005 to 2012 to investigate whether there was a relationship between morphology and pitfalls, and whether different surgical strategies had been used according to these pitfalls. During this review process the authors noted 4 distinct morphological aspects. These 4 aspects led to a review of the English and French literature on blister aneurysms in which imaging was available, to determine whether other cases could also be classified into the same 4 subgroups based on these morphological aspects. results The retrospective review of the authors' series of 10 patients allowed a division into 4 distinct subtypes: Type I (classic), Type II (berry-like), Type III (longitudinal), and Type IV (circumferential). These subtypes may at times be progressive stages in the arterial anomaly, and could represent a continuum. Each subtype described in this paper presented its own pitfalls and required specific surgical adaptations. Upon reviewing the literature the authors retained 35 studies involving a total of 61 cases of blister aneurysms, and all cases...

show abstract

Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister–Like Aneurysms

Cited by 101 publications

References 23 publications

The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

Safety of Preprocedural Antiplatelet Medication in Coil Embolization of Ruptured Cerebral Aneurysms at the Acute Stage

Morphological aspects of blister aneurysms and nuances for surgical treatment

Contact Info

Product

Resources

About