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  • Blister aneurysms of the carotid artery: systematic review of management options Yahya Khormi M.D, Cian O’Kelly M.D, MSc, FRCS (C) Neurosurgery Division University Of Alberta

    Final Number:

    Yahya H Khormi MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Blister aneurysms (BA) are a rare subtype of intracranial aneurysms. Whether treated with surgical or endovascular approaches, these fragile aneurysms carry an elevated risk of morbidity due to their increased likelihood of intraprocedural rupture.

    Methods: We conducted a systematic review of all ruptured internal carotid BA papers between 1980 and 2012. We restricted our analysis to papers, which included individual level patient data describing demographics, presentations, aneurysm location, management and outcomes.

    Results: We have identified eighty-one patients with sufficient data to permit analysis. 80 % were female. The mean age at presentation was 52 years (range 24-74). 25 % were poor clinical grade. Fifty-four were treated surgically (direct surgical repair, wrapping, trapping with or without bypass) and twenty-seven were treated using endovascular methods (coiling, stent assisted coiling, stent alone, or trapping/vessel occlusion). Intraprocedural rupture rates were relatively high at 33 %. While definitive conclusions are difficult, there was a trend towards improved outcomes with both surgical and endovascular trapping approaches.

    Conclusions: BAs remain challenging vascular lesions. Trapping may avoid some of the morbidity associated with direct repair strategies. Further comparative studies are needed to define the optimal approach to these aneurysms.

    Patient Care: by approving the best treatment option for blister aneurysm will decrease morbidities and mortalities of this disease .

    Learning Objectives: Studies addressing proper management of BBA are multiple one center focused small trials show different techniques, opinions and recommendations, indicate the need to review all BBA papers to find out the best treatment option for this kind of aneurysm.

    References: Nancy McLaughlin, Mathieu Laroche, Michel W. Bojanowski,Surgical Management of Blood Blister–like Aneurysms of the Internal Carotid Artery,WORLD NEUROAURGERY, 74 [4/5]: 483-493, OCTOBER/NOVEMBER 2010. Koji Kamijo, M.D., and Toru Matsui, M.D., D.M.Sc.Acute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister–like aneurysm of the internal carotid artery, J Neurosurg / Volume 113 / October 2010. MUSTAFA K. BAS¸KAYA, M.D., AZAM S. AHMED, M.D., ÖZKAN ATES¸, M.D. AND DAVID NIEMANN, M.D,Surgical treatment of blood blister–like aneurysms of the supraclinoid internal carotid artery with extracranial–intracranial bypass and trapping, Neurosurg Focus 24 (2):E13, 2008. SOOK YOUNG SIM, M.D., YONG SAM SHIN, M.D., PH.D., KYUNG GI CHO, M.D., PH.D., SUN YONG KIM, M.D., PH.D., SE HYUK KIM, M.D., PH.D., YOUNG HWAN AHN, M.D., PH.D., SOO HAN YOON, M.D., PH.D., AND KI HONG CHO, M.D., PH.D.Blood blister–like aneurysms at nonbranching sites of the internal carotid artery,J Neurosurg 105:400–405, 2006 Naoki Otani *, Yoshio Takasato, Hiroyuki Masaoka, Takanori Hayakawa, Yoshikazu Yoshino, Hiroshi Yatsushige, Kyoko Sumiyoshi, Hiroki Miyawaki, Chikashi Aoyagi, Satoru Takeuchi, Go Suzuki, Clinical and radiological findings and surgical management of ruptured aneurysms at the non-branching sites of the internal carotid artery, Journal of Clinical Neuroscience 16 (2009) 1018–1023 . Jae-Whan Lee & Hak-Gi Choi & Jin-Young Jung & Seung-Kon Huh & Kyu-Chang Lee, Surgical strategies for ruptured blister-like aneurysms arising from the internal carotid artery: a clinical analysis of 18 consecutive patients, Acta Neurochir (2009) 151:125–130 DOI 10.1007/s00701-008-0165-5 . TORSTEIN R. MELING, M.D., PH.D.,1 ANGELIKA SORTEBERG, M.D., PH.D.,1 SØREN J. BAKKE, M.D.,2 HALDOR SLETTEBØ, M.D.,1 JUHA HERNESNIEMI, M.D., PH.D.,3 AND WILHELM SORTEBERG, M.D., PH.D.1Blood blister–like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome, J Neurosurg 108:662–671, 2008 . Byung-Hee Lee, M.D.,1 Byung Moon Kim, M.D.,2 Moon Sun Park, M.D.,3 Sung Il Park, M.D.,4 Eun Chul Chung, M.D.,2 Sang Hyun Suh, M.D.,5 Chun Sik Choi, M.D.,6 Yu Sam Won, M.D.,6 and In Kyu Yu, M.D.1,Reconstructive endovascular treatment of ruptured blood blister–like aneurysms of the internal carotid artery, J Neurosurg 110:431–436, 2009 Noriaki Matsubara & Shigeru Miyachi & Nobuhiro Tsukamoto & Takashi Izumi & Takehiro Naito & Kenichi Haraguchi & Toshihiko Wakabayashi, Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid arteryActa Neurochir (2011) 153:287–294 DOI 10.1007/s00701-010-0898-9 JAE HYO PARK, M.D.,1 IN SUNG PARK M.D.,2 DAE HEE HAN, M.D.,1SEONG HYUN KIM, M.D.,3 CHANG WAN OH, M.D.,3 JEONG-EUN KIM, M.D.,1HYUN JIB KIM, M.D.,3 MOON HEE HAN, M.D.,4 AND O-KI KWON, M.D.Endovascular treatment of blood blister–like aneurysms of the internal carotid artery, J Neurosurg 106:812–819, 2007.

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