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  • Endovascular management of ruptured intracranial blister aneurysms

    Final Number:

    Ramsey Ashour MD; stephen dodson; Jacques J. Morcos MD, FRCS(Eng), FRCS(Ed); Mohammad Ali Aziz-Sultan MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Intracranial 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.

    Methods: All consecutive intracranial blister aneurysm cases treated using an endovascular approach at our institution between January 2009 and January 2012 were retrospectively analyzed.

    Results: Over the study period, 9 patients with blister aneurysms underwent 11 endovascular interventions. In various combinations, stents were used in 8/11, coils were used in 5/11, and Onyx was used in 3/11 procedures. At mean angiographic follow-up of 200 days, 8/9 aneurysms were completely or near-completely occluded by endovascular means alone requiring no further treatment, and 1 aneurysm required surgical bypass and trapping after one failed surgical and two failed endovascular treatments. At mean clinical follow-up of 416 days, mRS scores were improved in 6, stable in 2, and worsened in 1 patient. One complication occurred in 11 procedures (9%), resulting in a permanent residual neurologic deficit. No unintended endovascular parent vessel sacrifice, intra-procedural aneurysmal ruptures, anti-platelet-related complications, post-treatment aneurysmal re-ruptures, or deaths occurred.

    Conclusions: This series highlights both the spectrum and limitations of endovascular techniques currently utilized to treat blister aneurysms, including a novel application of stent-assisted Onyx embolization. Long-term follow-up and larger experiences are required to better define the role of endovascular therapy in the management of these difficult lesions.

    Patient Care: Highlights the current state-of-the-art of endovascular therapy for blister aneurysms, increases awareness of technical pitfalls and limitations of endovascular techniques in an era where enthusiasm for devices exceeds experience with their use.

    Learning Objectives: By the conclusion of this session, participants should understand the unique features of blister aneurysms that make them difficult to treat by standard open surgical or endovascular methods and be aware of the spectrum and limitations of various endovascular techniques available for treating these difficult lesions.

    References: 1. Shigeta H, Kyoshima K, Nakagawa F, Kobayashi S. Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta neurochirurgica. 1992;119(1-4):42-48. 2. Vishteh AG, Spetzler RF. Blister or berry aneurysm. Journal of neurosurgery. Dec 1999;91(6):1062-1063. 3. Abe M, Tabuchi K, Yokoyama H, Uchino A. Blood blisterlike aneurysms of the internal carotid artery. Journal of neurosurgery. Sep 1998;89(3):419-424. 4. Ogawa A, Suzuki M, Ogasawara K. Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery. Sep 2000;47(3):578-583; discussion 583-576. 5. Ishikawa T, Nakamura N, Houkin K, Nomura M. Pathological consideration of a "blister-like" aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery. Feb 1997;40(2):403-405; discussion 405-406. 6. Andrews BT, Brant-Zawadzki M, Wilson CB. Variant aneurysms of the fenestrated basilar artery. Neurosurgery. Feb 1986;18(2):204-207. 7. Meling TR, Sorteberg A, Bakke SJ, Slettebo H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. Journal of neurosurgery. Apr 2008;108(4):662-671. 8. Regelsberger J, Matschke J, Grzyska U, et al. Blister-like aneurysms--a diagnostic and therapeutic challenge. Neurosurgical review. Oct 2011;34(4):409-416. 9. Yoshimoto Y, Ochiai C, Nagai M. Cerebral aneurysms unrelated to arterial bifurcations. Acta neurochirurgica. 1996;138(8):958-963; discussion 963-954. 10. Sim SY, Shin YS, Cho KG, et al. Blood blister-like aneurysms at nonbranching sites of the internal carotid artery. Journal of neurosurgery. Sep 2006;105(3):400-405. 11. Lee JW, Choi HG, Jung JY, Huh SK, Lee KC. Surgical strategies for ruptured blister-like aneurysms arising from the internal carotid artery: a clinical analysis of 18 consecutive patients. Acta neurochirurgica. Feb 2009;151(2):125-130. 12. McNeely PD, Clarke DB, Baxter B, Vandorpe RA, Mendez I. Endovascular treatment of a "blister-like" aneurysm of the internal carotid artery. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. Aug 2000;27(3):247-250. 13. Park JH, Park IS, Han DH, et al. Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. Journal of neurosurgery. May 2007;106(5):812-819. 14. Tanoue S, Kiyosue H, Matsumoto S, Yamashita M, Nagatomi H, Mori H. Ruptured "blisterlike" aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization. Case report. Journal of neurosurgery. Jul 2004;101(1):159-162. 15. Kim BM, Chung EC, Park SI, Choi CS, Won YS. Treatment of blood blister-like aneurysm of the internal carotid artery with stent-assisted coil embolization followed by stent-within-a-stent technique. Case report. Journal of neurosurgery. Dec 2007;107(6):1211-1213. 16. Islam MS, Manabe H, Hasegawa S, Takemura A, Nagahata M. 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. Minimally invasive neurosurgery : MIN. Jun 2004;47(3):165-168. 17. Ahn JY, Cho JH, Jung JY, Lee BH, Yoon PH. Blister-like aneurysms of the supraclinoid internal carotid artery: challenging endovascular treatment with stent-assisted coiling. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. Sep 2008;15(9):1058-1061. 18. Ihn YK, Kim SH, Sung JH, Kim TG. The efficacy of endovascular treatment of ruptured blood blister-like aneurysms using stent-assisted coil embolization. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences. Dec 2012;18(4):432-441. 19. Lee BH, Kim BM, Park MS, et al. Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. Journal of neurosurgery. Mar 2009;110(3):431-436. 20. Kim YW, Park IS, Baik MW, Jo KW. Endovascular treatment of blood blister-like aneurysms using multiple self-expanding stents. Journal of Korean Neurosurgical Society. Feb 2011;49(2):116-119. 21. Fiorella D, Albuquerque FC, Deshmukh VR, et al. Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery. Aug 2006;59(2):291-300; discussion 291-300. 22. Gaughen JR, Jr., Hasan D, Dumont AS, Jensen ME, McKenzie J, Evans AJ. The efficacy of endovascular stenting in the treatment of supraclinoid internal carotid artery blister aneurysms using a stent-in-stent technique. AJNR. American journal of neuroradiology. Jun 2010;31(6):1132-1138. 23. Consoli A, Nappini S, Renieri L, Limbucci N, Ricciardi F, Mangiafico S. Treatment of two blood blister-like aneurysms with flow diverter stenting. Journal of neurointerventional surgery. May 2012;4(3):e4. 24. Cinar C, Oran I, Bozkaya H, Ozgiray E. Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy. Neuroradiology. Jan 16 2013.

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