Flow diverter embolization device for endovascular treatment of ruptured blister and wide necked very small aneurysms

Abstract

PurposeRuptured blood blisters (BBA) and very small, wide necked aneurysms (VSA) remain challenging lesions to treat due to their small size, wide necks, and thin, fragile walls. In the present study, we reviewed our experience with these aneurysms treated by flow diversion.MethodsA total of 18 patients with hemorrhage due to a ruptured BBAs and VSAs, treated with flow diversion between July 2014 and March 2016 were included in this study. We analyzed clinical and radiographic outcomes.ResultsA total of 12 (66.7%) VSAs and 6 (33.3%) BBAs were treated with flow diversion. Fifteen (83.3%) and three (16.7%) aneurysms were located on the internal carotid artery and the basilar artery, respectively. On admission, a GCS score of 15 and WFNS grade 1 were found in 14 (77.7%) patients, 3 patients had an admission GCS of 13 and WFNS grade 2, one had an admission GCS of 8 and WFNS of 4. Fisher CT grades 2, 3, and 4 were observed in 11 (61.1%), 1 (5.6%), and 6 (33.3%) patients, respectively. Flow diversion was performed on average 5.6 days after onset of hemorrhage. 6 months post-intervention angiography showed complete obliteration of the aneurysms in all patients.ConclusionOur findings indicate that flow diversion in the acute and subacute phase of hemorrhage is a reliable treatment for reducing complications in patients with BBAs and VSAs. In patients with poor clinical presentation it might be reasonable to delay treatment until the first signs of recovery become apparent.

Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

“…To our knowledge, this is the first study on FD in BBAs (of the ICA) in the acute setting. In addition to Capocci et al, some other studies suggest treatment deferral because of the high risk associated with DAPT for hemorrhagic complications particularly in cases where EVD placement is necessary ( 31 , 38 ). Considering the natural progressive course and high risk for rerupture and regrowth of ruptured BBAs, treatment delay is highly debatable and involves high risk.…”

“…To our knowledge, there is no article focusing on the early treatment of ruptured BBAs treated with FDs. There had been some mixed (early and delayed treatment fashion) data and only one aforementioned delayed treatment safety and efficacy report ( 3 , 8 , 25 , 30 , 33 , 35 , 38 ). Our results contribute to the safety profile of FDs in the early treatment period of ruptured BBAs of ICA with a similar outcome and complication rates compared to delayed treatment and overall data regardless of time to treatment.…”

Outcomes after Flow Diverter Treatment in Subarachnoid Hemorrhage: A Meta-Analysis and Development of a Clinical Prediction Model (OUTFLOW)

“…Baseline characteristics varied substantially among the studies due to the different inclusion criteria. Variation was observed in the types of aneurysms (several types [14,16,19,22,23,25,26,[28][29][30]32,33,36] versus a single type of aneurysm [7,15,17,18,20,21,24,27,31,34,35,37]), location (anterior versus posterior), clinical presentation, and the timing of treatment. For example, of patients with known World Federation of Neurosurgical Societies (WFNS) or Hunt and Hess (HH) grades at presentation (n = 348), 96 patients (28%, range 0-71%) showed an unfavorable WFNS or HH grade of 4 or 5.…”