Successful Staged Treatment for Ruptured Blister-Like Dissecting Aneurysm of the Intracranial Internal Carotid Artery: Acute GDC Embolization for the Blister-Like Aneurysm Followed by Proximal Occlusion with Extracranial-Intracranial Bypass in the Chronic Stage

Islam, Md. Zahidul; Manabe, Hideaki; Hasegawa, Shu; Takemura, Atsuhito; Nagahata, Morio

doi:10.1055/s-2004-818490

Cited by 28 publications

(11 citation statements)

References 8 publications

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“…Several subsequent reports highlighted the pitfalls associated with primary coiling of blister aneurysms, including high rates of early aneurysmal regrowth 18 24 26–28 33. For example, Park et al 27 performed seven endovascular coiling procedures (4 conventional, 2 stent-assisted, and 1 balloon-assisted) in four patients with ruptured ICA blister aneurysms; all four patients experienced aneurysmal regrowth, resulting in two early aneurysmal re-ruptures.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques

Ashour

Dodson

Aziz-Sultan

2014

J NeuroIntervent Surg

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BackgroundIntracranial blister aneurysms are rare lesions that are notoriously more difficult to treat than typical saccular aneurysms. High complication rates associated with surgery have sparked considerable interest in endovascular techniques, though not well-studied, to treat blister aneurysms.ObjectiveTo evaluate our experience using various endovascular approaches to treat blister aneurysms.MethodsAll consecutive blister aneurysms treated using an endovascular approach by the study authors over a 3-year period were retrospectively analyzed. A literature review was also performed.ResultsNine patients with blister aneurysms underwent 11 endovascular interventions. In various combinations, stents were used in 8/11, coils in 5/11, and Onyx in 3/11 procedures. At mean angiographic follow-up of 200 days, 8/9 aneurysms were completely occluded by endovascular means alone requiring no further treatment and 1/9 aneurysms required surgical bypass/trapping after one failed surgical and two failed endovascular treatments. At mean clinical follow-up of 416 days, modified Rankin Scale scores were improved in six patients, stable in two, and worsened in one patient. One complication occurred in 11 procedures (9%), resulting in a permanent neurologic deficit. No unintended endovascular parent vessel sacrifice, intraprocedural aneurysmal ruptures, antiplatelet-related complications, post-treatment aneurysmal re-ruptures, or deaths occurred.ConclusionThis series highlights both the spectrum and limitations of endovascular techniques currently used to treat blister aneurysms, including a novel application of stent-assisted Onyx embolization. Long-term follow-up and experience in larger studies are required to better define the role of endovascular therapy in the management of these difficult lesions.

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Section: Discussionmentioning

confidence: 99%

Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques

Ashour

Dodson

Aziz-Sultan

2014

J NeuroIntervent Surg

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“…Endovascular treatment (EVT) was recently attempted for BBA 3-5)9). A stent-assisted coil embolization was used to treat an acute BBA because of the typical appearance of a BBA with a small hemispherical bulge 4).…”

Section: Discussionmentioning

confidence: 99%

Salvage Surgical Treatment for Failed Endovascular Procedure of a Blood Blister-Like Aneurysm

Cho

Hwang

Nam

et al. 2012

J Cerebrovasc Endovasc Neurosurg

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The blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is a rare but clinically important cause of subarachnoid hemorrhage (SAH), which accounts for 0.5% of incidences of ruptured intracranial aneurysms. BBA is a thin-walled, broad-based aneurysm that lacks an identifiable neck and is one of the most difficult lesions to treat. In this paper, a case is presented of a 57-year-old woman with SAH. Her cerebral angiography demonstrated a small BBA on the dorsal wall of her right ICA. Endovascular treatment that consisted of a stent-within-a-stent was attempted, but the replacement of the second stent failed, and the aneurysm became bigger. Surgery was performed by clipping the BBA with a Sundt slim-line encircling graft clip. The patient completely recovered with no complications. This treatment may be a salvageable option for BBA, especially when endovascular treatment has failed.

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“…The difficulty of treatment has been documented in the literature with case series and reports of "novel" surgical treatment methods. [5][6][7]17,19 Blood blister-like aneurysms of the ICA pose a unique challenge to treatment in cerebrovascular neurosurgery. Their small size, ill-defined necks, and thin fragile walls make these aneurysms particularly difficult to treat.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of blood blister–like aneurysms of the supraclinoid internal carotid artery with extracranial–intracranial bypass and trapping

Başkaya

Ahmed²,

Ateş³

et al. 2008

FOC

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Object Blood blister–like aneurysms (BBAs) arise from the supraclinoid internal carotid artery (ICA) at non-branching sites. These aneurysms are challenging to treat primarily with either surgical clip placement or endovascular therapy. The authors describe a series of 4 patients who presented with high-grade subarachnoid hemorrhage (SAH) due to a BBA, which was treated with an extracranial–intracranial (EC–IC) bypass followed by trapping of the aneurysm. Methods Four patients presented with SAH due to a BBA of the ICA. Three of these patients were treated with an endovascular procedure; following the vasospasm period, definitive treatment with EC–IC bypass followed by trapping of the aneurysmal parent vessel was performed. Results Two of the patients who were treated endovascularly suffered rebleeding prior to bypass and trapping. Three of the 4 patients had a good outcome (modified Rankin Scale Score 1 or 2), and 1 patient who suffered 2 episodes of rebleeding died. Conclusions Treatment of BBAs of the ICA remains difficult, particularly in the setting of high-grade SAH. Patients with this challenging condition often require multiple procedures and have a high incidence of rebleeding. Definitive treatment of these aneurysms consists of EC–IC bypass and surgical or endovascular trapping.

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Successful Staged Treatment for Ruptured Blister-Like Dissecting Aneurysm of the Intracranial Internal Carotid Artery: Acute GDC Embolization for the Blister-Like Aneurysm Followed by Proximal Occlusion with Extracranial-Intracranial Bypass in the Chronic Stage

Cited by 28 publications

References 8 publications

Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques

Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques

Salvage Surgical Treatment for Failed Endovascular Procedure of a Blood Blister-Like Aneurysm

Surgical treatment of blood blister–like aneurysms of the supraclinoid internal carotid artery with extracranial–intracranial bypass and trapping

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