A Systematic Review and Meta-Analysis of Treatment and Outcome of Blister-Like Aneurysms

Peschillo, Simone; Cannizzaro, Delia; Caporlingua, Alessandro; Missori, Paolo

doi:10.3174/ajnr.a4606

Cited by 84 publications

(89 citation statements)

References 10 publications

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“…33,39 It is also of interest that systematic reviews have shown treatment of blister aneurysms with FDs to result in a higher rate of thromboembolic events compared with non-FD-mediated endovascular treatment, but there was no significant difference in the rate of rebleeding. 44,48 Fur- thermore, although use of FD technology was found to provide a statistically significantly higher rate of mid-to long-term occlusion and a lower rate of retreatment, the difference in the rate of good neurological outcome was not statistically significant between groups.…”

mentioning

confidence: 76%

Endovascular treatment of blister aneurysms

Peitz¹,

Sy²,

Grandhi³

2017

Neurosurgical Focus

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Blister aneurysms are rare cerebrovascular lesions for which the treatment methods are reviewed here, with a focus on endovascular options. The reported pathogenesis of blister aneurysms varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. There is consensus on the excessive fragility of blister aneurysms and their parent vessels, which makes clipping technically difficult. Open surgical treatment is associated with high rates of complications, morbidity, and mortality; endovascular treatment is a promising alternative. Among endovascular treatment options, deconstructive treatment has been associated with higher morbidity compared with reconstructive methods such as direct embolization, stent- or balloon-assisted direct embolization, stent monotherapy, and flow diversion. Flow diversion has been associated with higher technical success rates and similar clinical outcomes compared with non–flow diverting treatment methods. However, delayed aneurysm occlusion and the need for antiplatelet therapy are potential drawbacks to flow diversion that must be considered when choosing among treatment methods for blister aneurysms.

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mentioning

confidence: 76%

Endovascular treatment of blister aneurysms

Peitz¹,

Sy²,

Grandhi³

2017

Neurosurgical Focus

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“…9 Endovascular procedures included coiling, balloon/stent-assisted coiling, single stent alone, multiple stents, parent artery occlusion, FD alone or with coils. 10 Because of the fragile paper-thin walls of blister aneurysms, surgical clipping met with high rate of intraoperative ruptures which finally led to sacrificing the parent artery. 8,[11][12][13] For the same reason, primary or stent-assisted coiling of blisters carry a high risk of rupture and hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Flow Diversion in Ruptured Blood Blister Aneurysms: Single Centre Experience

Rahul

Santhosh

Mehta

et al. 2017

J Clin Interv Radiol ISVIR

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Blood blister aneurysms are extremely rare, and its treatment continues to be controversial. Although surgery was the only available treatment a decade ago, today newer endovascular devices such as flow diverters (FDs) appears to have very low complication rates with good long-term results. We analyzed our data of seven patients who angiographically had features of a blister aneurysm. All these patients presented with subarachnoid hemorrhage (SAH). Six of these were in anterior circulation, all of which were in internal carotid artery (ICA) and one was in a P1 segment of posterior cerebral artery (PCA). All of the patients except one in PCA were treated with FDs. One of the patients died (14.3%) following the procedure secondary to thrombosis of FD. Rest of the patients did well postprocedure with the good clinical outcome (modified Rankin Scale [mRS] of less than or equal to 2 at 1-month follow-up) in 85.7% patients. Five of the patients showed complete obliteration of an aneurysm (83.3%) on 6-month follow-up angiography. The only patient with an aneurysm in PCA showed persistence of an aneurysm and this particular lesion was instead treated by a single stent. Blister aneurysms pose diagnostic and therapeutic challenges and demand prompt treatment. Considering that all patients who were treated with FD had complete obliteration, it can be inferred that FD can be the treatment of choice in patients with blister aneurysms presenting with SAH. Further, with the introduction of small vessel FD, thrombotic complications may reduce, lowering the morbidity and mortality. Isolated stenting may not be an optimal treatment of a blister aneurysm.

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“…Currently, the therapeutic protocol for BBAs of the supraclinoid ICA is rarely mentioned in the literature, and studies more often focus on specific therapeutic methods 5, 6. In fact, treatment of BBAs of the supraclinoid ICA abides by certain principles.…”

Section: Classification and Therapeutic Protocol For Bbasmentioning

confidence: 99%

“…BBAs can grow in many sites, such as the supraclinoid internal carotid artery (ICA), middle cerebral artery, anterior communicating artery, basilar artery, and posterior cerebral artery 3, 4. Among these sites, most BBAs arise from the supraclinoid ICA 5, 6. BBAs of the supraclinoid ICA are distinguished from saccular aneurysms by several unique characteristics, such as a hemispheric and broad-based appearance, a lack of an identifiable neck originating from a nonbranching site of an artery, instability, morphological changes on short-term angiographic follow-up, fragility and the tendency to rupture or regrow 7, 8.…”

Section: Introductionmentioning

confidence: 99%

“…However, until now, there has been no consensus as to how to treat BBAs of the supraclinoid ICA. During a literature review, we identified several techniques that have been applied to treat BBAs of the supraclinoid ICA, including direct clipping 12, suturing 13, clipping after wrapping 14, 15, the application of encircling clips 16, endovascular or surgical trapping with or without extra bypass 17, 18, coiling 19, stenting or flow-diverting stents 20 and multiple overlapping stents 5, 6.…”

Section: Introductionmentioning

confidence: 99%

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Current status of the treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery: A review

Ji¹,

Guo²,

Huang³

et al. 2017

Int. J. Med. Sci.

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Currently, the treatment of blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA) is challenging and utilizes many therapeutic methods, including direct clipping and suturing, clipping after wrapping, clipping after suturing, coil embolization, stent-assisted coil embolization, multiple overlapping stents, flow-diverting stents, covered stents, and trapping with or without bypass. In these therapeutic approaches, the optimal treatment method for BBAs has not yet been defined based on the current understanding of BBAs of the supraclinoid ICA. Therefore, in this study, we aimed to review the literature from PubMed to discuss and analyze the pros and cons of the above approaches while adding our own viewpoints to the discussion. Among the surgical methods, direct clipping was the easiest method if the compensation of the collateral circulation of the intracranial distal ICA was sufficient or direct clipping did not induce stenosis in the parent artery. In addition, the clipping after wrapping technique should be chosen as the optimal surgical modality to prevent rebleeding from these lesions. Among the endovascular methods, multiple overlapping stents (≥3) with coils may be a feasible alternative for the treatment of ruptured BBAs. In addition, flow-diverting stents appear to have a higher rate of complete occlusion and a lower rate of retreatment and are a promising treatment method. Finally, when all treatments failed or the compensation of the collateral circulation of the intracranial distal ICA was insufficient, the extracranial-intracranial (EC-IC) arterial bypass associated with surgical or endovascular trapping, a complex and highly dangerous method, was used as the treatment of last resort.

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A Systematic Review and Meta-Analysis of Treatment and Outcome of Blister-Like Aneurysms

Cited by 84 publications

References 10 publications

Endovascular treatment of blister aneurysms

Endovascular treatment of blister aneurysms

Flow Diversion in Ruptured Blood Blister Aneurysms: Single Centre Experience

Current status of the treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery: A review

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