Aneurysms at Nonbranching Sites in the Supraclinoid Portion of the Internal Carotid Artery: Internal Carotid Artery Trunk Aneurysms

Ogawa, Akira; Suzuki, Michiyasu; Ogasawara, Kuniaki

doi:10.1097/00006123-200009000-00008

Cited by 173 publications

(364 citation statements)

References 18 publications

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“…Not only focal wall defects associated with arteriosclerosis-induced ulceration and penetration of the internal elastic lamina, but also high female susceptibility under certain conditions may play important roles in the development of BBAs. 1,6,14 Hypertension has been associated with intra-and postoperative aneurysm rupture, 14 which was borne out in the present study-four of five patients with ruptured BBAs also exhibited hypertension. We surmise that neck tearing occurs more frequently in hypertensive patients because of a difference in the stiffness of the atherosclerotic parent artery adjacent to the ICA wall at which the BBA is located.…”

Section: Clinical Features Of Bbassupporting

confidence: 58%

“…14 In our study, more than one half of the patients had BBAs on the right side and a history of hypertension, findings that resemble those of others. 13,14,20 Almost all patients had atherosclerotic parent arteries adjacent to the BBAs, but there was no relation to ICA dissection in those in the present study.…”

Section: Clinical Features Of Bbascontrasting

confidence: 55%

“…13,14,23 Saccular aneurysms can occur at nonbranching sites along the anterior aspects of the supraclinoid segment of the ICA, 14 but BBAs with fragile walls and necks represent the most common types of lesions found in this area.…”

Section: Clinical Features Of Bbasmentioning

confidence: 99%

“…1 It has also been reported that BBAs occur predominantly on the right side and in females. 13 Frequently, these lesions are associated with hypertension, 13,14,20 arteriosclerosis, 1,6,20 and ICA dissection. 14 In our study, more than one half of the patients had BBAs on the right side and a history of hypertension, findings that resemble those of others.…”

Section: Clinical Features Of Bbasmentioning

confidence: 99%

“…1 The challenge for surgeons is to determine the best treatment (clipping, clipping onto wrapping, or trapping). To date, applying clips onto wrapping of various materials has been proposed as the best method for the treatment of BBAs; 1,13,14 ICA trapping, clipping, and wrapping alone are associated with much worse outcomes.…”

Section: Surgical Outcomes Associated With Bbasmentioning

confidence: 99%

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Blood blister–like aneurysms at nonbranching sites of the internal carotid artery

Sim¹,

Shin²,

Cho³

et al. 2006

JNS

123

143

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Object The clinical features of blood blister–like aneurysms (BBAs) that arise at nonbranching sites of the internal carotid artery (ICA) differ from those of saccular aneurysms. In this study, the authors attempt to describe optimal treatments for BBAs, which have yet to be clearly established. Methods Ten of 483 patients with aneurysmal subarachnoid hemorrhage who had been seen at the authors’ institution between March 2001 and June 2005 had intraoperatively confirmed BBAs at nonbranching sites of the ICA. All ten patients were women between the ages of 37 and 64 years (mean age 49.3 years); five had a history of hypertension. The BBAs were localized to the right side of the ICA in seven cases. All patients were successfully treated; clipping was undertaken in six, clipping combined with wrapping in three, and trapping in one. These methods were used in conjunction with various other surgical techniques such as brain relaxation by draining cerebrospinal fluid, anterior clinoidectomy, exposing the cervical ICA, gentle subpial dissection (for aneurysms that adhered to the frontal lobe), complete trapping of the ICA before clipping, and protecting the brain. Clip slippage occurred at the end of dural closing in two cases; the aneurysm was completely obliterated using multiple clips combined with ICA stenosis in one of these cases and ICA trapping with good collateral flow in the other. An excellent clinical outcome was achieved in eight patients, whereas two patients were disabled from massive vasospasm. The authors retrospectively reviewed radiological and surgical data in all cases to determine which treatment methods produced a favorable outcome. Conclusions Blood blister–like aneurysms located at nonbranching sites of the ICA are difficult to treat. Preoperative awareness and careful consideration of these lesions during surgery can prevent poor clinical outcomes.

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