The Blood Blister Like-aneurysm: Usefulness of Sundt Clip

Park, Tae Joon; Kim, Ki Hong; Cho, Jae Hoon

doi:10.7461/jcen.2017.19.3.171

Cited by 10 publications

(7 citation statements)

References 15 publications

(25 reference statements)

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“…They are small broad-based lesions that resemble an ulcer, with a fragile wall that is more associated to high rupture risk when compared to saccular aneurysms. 10) Some studies considered that its pathology is associated to an arterial dissection. Ruptured BBAs consist of a platelet plug covering a thin layer of adventitia, which overlies a defect in the intima and media that lacks the usual collagen layer.…”

Section: Discussionmentioning

confidence: 99%

Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

Paiva

Aguiar

Flores

et al. 2021

J Cerebrovasc Endovasc Neurosurg

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Blood Blister-like aneurysms are intracranial non-saccular aneurysms with higher rupture risk due to its fragile wall. Diagnosis is performed in the acute phase of a subarachnoid hemorrhage. There are several treatment options based on reconstructive or deconstructive techniques. This paper aims to discuss the limitations of microsurgery clipping for a ruptured blister aneurysm. We report on a case of a female patient presented with a Fisher III subarachnoid hemorrhage. Cerebral angiography revealed an internal carotid artery blister aneurysm. Initially microsurgery clipping was successfully performed. However, after a few days the patient presented new subarachnoid hemorrhage. The new cerebral angiography showed growth of the previously clipped aneurysm, with displacement of the clip from the position adjacent to the artery. High-flow bypass was performed obtaining definitive treatment. This is a definitive approach for blister aneurysms. If microsurgery clipping is chosen, a strict follow-up is required due to the dynamic nature of this lesion and the chance of re-bleeding even after successfully clipping.

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Section: Discussionmentioning

confidence: 99%

Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

Paiva

Aguiar

Flores

et al. 2021

J Cerebrovasc Endovasc Neurosurg

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“…32 The various microsurgical treatment options such as trapping, clipping and wrapping have also been reported to be associated with an increased procedural risk due to the features of BBAs and the location on the dorsal vessel wall, which makes the surgical access even more difficult. 21,22,33 Surgical trapping carries similar risks to endovascular PVO and requires adequate collaterals or EC-IC bypass if these are not present. Direct clipping of these aneurysms carries a significant risk of intraoperative rupture, as occurred in one of our cases, and this risk may be as high as 50%.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical clipping and endovascular flow diversion of ruptured anterior circulation blood blister-like aneurysms

et al. 2018

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Background Detection and treatment of blister-like intracranial aneurysms as a source of subarachnoid hemorrhage (SAH) can be challenging. In the past the results of both microsurgical and endovascular treatment were difficult. We present our experience with the treatment of blister-like aneurysms in the acute phase of SAH using microsurgical clipping, endovascular parent vessel occlusion or flow diversion. Methods A retrospective analysis of the cases of eight consecutive patients presenting in the acute phase after SAH from an intracranial blister aneurysm was performed. The demographic data of the patients, aneurysm characteristics, the clinical results of the treatment and the follow-up examinations were recorded. Procedural safety margins and aneurysm occlusion on follow-up digital subtraction angiography were the main interest of this evaluation. Results Between January 2012 and November 2017 a total of eight ruptured blister aneurysms were treated in our center, six patients endovascularly. Five patients were treated in the acute phase of SAH, four by flow diversion. All endovascular procedures were feasible and no procedure-related complications were observed, especially no recurrent hemorrhage. In the first angiographic follow-up all blood blister-like aneurysms were completely occluded; two of the six patients treated by flow diverter implantation showed mild, transient intimal hyperplasia without clinical symptoms or the need for treatment. Conclusions Endovascular flow diversion is a viable option in the acute phase after SAH due to the rupture of a blister aneurysm. Implants with reduced thrombogenicity, obviating dual-platelet function inhibition, and flow diverters for vessel bifurcations would extend the indications for this treatment modality.

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“…Park et al, 2017 (14) state that wrapping alone may not prevent rebleeding or regrowth of BBA, but wrapping with suturing or clipping can be useful choice for reinforcement of BBA. Ogawa et al, 2000 (19) and Ji et al, 2017 (5) think that clipping on wrapping material is one with the best results to treat blistertype aneurysms.…”

Section: Wrappingmentioning

confidence: 99%

“…If we compare them to the saccular aneurysm, it is noticed that they affect a younger population (1,3,13) . The first description was made by Sundt and Murphey in 1969, where they anatomically defined the aneurysm as a shallow and broad based or semi fusiform focal protrusion (1,3,4,6,11,(14)(15)(16) . The most common location is the supraclinoid internal carotid artery (ICA) (1,(3)(4)(5)7,(10)(11)(13)(14)(15)(17)(18) .…”

Section: Introductionmentioning

confidence: 99%

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

Aguiar

Santos

et al. 2019

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introduction: Blister aneurysms are of uncertain pathogenesis and are a vascular lesion located in the brain. Overall, they represent 0.3% - 1.0% of all intracranial aneurysms and 0.9% - 6.5% of ruptured intracranial aneurysms. They are associated with high morbidity and mortality. Even with the first description being from 1969, there is still debate in the literature about which type of treatment is the best: surgical or endovascular. In this review, we focus on the surgical management. Method: The authors performed a review of available surgical techniques used for blood blister-like aneurysms treatment. Pubmed database was used as search source introducing blister-like aneurysm and blister aneurysms as keywords. The most relevant articles and those that focused on surgical treatment techniques were selected. Discussion: The most used surgical methods are clipping, trapping, wrapping and bypass. As main features of each technique, we can highlight clipping with good efficiency, when there is good neck exposure; trapping being employed in ruptured aneurysm; wrapping for avulsion and bypass that promotes vascularization to the distal territory of the aneurysm. Conclusion: The endovascular method has shown to be promising and efficient. However, different surgical techniques are still being employed based on their efficiency when facing certain surgical scenarios.Keywords: Neurosurgery, Subarachnoid hemorrhage, Intracranial aneurysm, Endovascular proceduresRESUMOIntrodução: Aneurismas cerebrais blister-like são lesões vasculares de patogenia incerta. De modo geral, representam 0.3%-1.0% de todos aneurismas intracranianos e 0.9% - 6.5% dos aneurismas intracranianos que rompem. Estão associados a alta morbimortalidade. Mesmo com a primeira descrição sendo de 1969, ainda há debate na literatura sobre qual tipo de tratamento é o melhor: cirúrgico ou endovascular. Nessa revisão, focamos no tratamento cirúrgico. Métodos: Os autores realizaram uma revisão das técnicas cirúrgicas utilizadas para tratamento de aneurismas blister-like. A plataforma Pubmed foi utilizada para a pesquisa das palavras chaves “blister-like aneurysm” e “blister aneurysm”. Os artigos de maior relevância e aqueles que enfatizam as técnicas cirúrgicas foram selecionados. Discussão: Os métodos cirúrgicos empregados são clipagem, trapping, wrapping e bypass. Quanto às características de cada método, podemos salientar a eficácia da clipagem, quanto melhor for a exposição do aneurisma; o uso do trapping em situações de rompimento do aneurisma; wrapping para casos em que houve avulsão do aneurisma e by-pass que promove a vascularização distal ao aneurisma. Conclusão: O método endovascular tem se mostrado promissor e efetivo. No entanto, as diferentes técnicas cirúrgicas ainda são empregadas e defendidas devido a sua eficiência frente certos cenários cirúrgicos.Descritores: Neurocirurgia, Hemorragia subaracnóidea, Aneurisma intracraniano, Procedimentos endovasculares

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The Blood Blister Like-aneurysm: Usefulness of Sundt Clip

Cited by 10 publications

References 15 publications

Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

Microsurgical clipping and endovascular flow diversion of ruptured anterior circulation blood blister-like aneurysms

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

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