Blister-like Aneurysms in Atypical Locations: A Single-Center Experience and Comprehensive Literature Review

Peschillo, Simone; Miscusi, Massimo; Caporlingua, Alessandro; Cannizzaro, Delia; Santoro, Antonio; Delfini, Roberto; Guidetti, Giulio; Missori, Paolo

doi:10.1016/j.wneu.2015.05.077

Cited by 33 publications

(29 citation statements)

References 16 publications

(15 reference statements)

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“…15,20,22 These broad, shallow lesions occur at the artery sidewall, as opposed to branching points seen with typical saccular aneurysms, and are most often located on the supraclinoid internal carotid artery (ICA), but have also been described at anterior cerebral artery and middle cerebral artery locations. 24,27 Reconstructive techniques, such as attempts at direct surgical clipping, often result in tearing a hole in the artery, whereas attempts at endovascular coiling can lead to puncture of the wall. Indirect surgical repair, such as use of encircling clips, or wrapping and clipping, has been described with numerous technical variations, but the long-term followup of these techniques is uncertain, because they do not OBJECTIVE Ruptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall.…”

Section: Focusmentioning

confidence: 99%

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Ryan

Khan

Barco

et al. 2017

Neurosurgical Focus

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OBJECTIVERuptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall. Historical challenges with both open microsurgical approaches and intrasaccular endovascular approaches have led to increased use of flow diversion for management of these aneurysms. However, the optimum paradigm, including timing of treatment, use of dual antiplatelet therapy, and number of flow-diverter devices to use remains unknown. The authors describe their experience with ruptured blister aneurysms treated with flow diversion at their institution, and discuss rates of rebleeding and number of devices used.METHODSAll patients presenting with subarachnoid hemorrhage from a ruptured blister aneurysm and treated with Pipeline flow diversion were identified. Patient demographic data, clinical status and course, need for external ventricular drain (EVD), timing of treatment, and angiographic details and follow-up were recorded.RESULTSThere were 13 patients identified (11 women and 2 men), and 4 had multiple aneurysms. Two aneurysms were treated on initial angiography, with average time to treatment of 3.1 days for the remainder, after discussion with the family and institution of dual antiplatelet therapy. Device placement was technically successful in all patients, with 2 patients receiving 2 devices and the remainder receiving 1 device. There was 1 intraoperative complication, of a wire perforation causing intracerebral hemorrhage requiring decompressive craniectomy. Three patients had required EVD placement for management of hydrocephalus. There was no rebleeding from the target lesion; however, one patient had worsening intraventricular hemorrhage and another had rupture of an unrecognized additional aneurysm, and both died. Of the other 11 patients, 10 made a good recovery, with 1 remaining in a vegetative state. Nine underwent follow-up angiography, with 5 achieving complete occlusion, 2 with reduced aneurysm size, and 2 requiring retreatment for aneurysm persistence or enlargement. There were no episodes of delayed rupture.CONCLUSIONSPipeline flow diversion is a technically feasible and effective treatment for ruptured blister aneurysms, particularly in good-grade patients without hydrocephalus. Patients with a worse grade on presentation and requiring EVDs may have higher risk for bleeding complications and poor outcome. There was no rebleeding from the target lesion with use of a single device in this series.

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Section: Focusmentioning

confidence: 99%

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Ryan

Khan

Barco

et al. 2017

Neurosurgical Focus

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“…Since the initial description as ICA aneurysms, they have been reported in the middle cerebral artery (MCA), anterior cerebral artery, anterior communicating artery, basilar artery, and posterior inferior cerebellar artery 2 3. Presentation is typically with acute subarachnoid hemorrhage (aSAH) related to aneurysmal rupture.…”

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confidence: 99%

Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature

Linfante

Mayich

Sonig

et al. 2016

J NeuroIntervent Surg

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“…Specifically, there have been reports of blisterlike aneurysms in the middle cerebral artery, anterior communicating artery, and vertebrobasilar circulation. [4][5][6][7] The above characteristics make them particularly difficult to treat, and patients with these lesions often have a poor outcome. Numerous treatment methods have been proposed: microsurgery, including clipping techniques, titanium vascular miniclip internal carotid artery repair, vessel graft wrapping reinforced by clips, trapping, parent vessel occlusion, and revascularization; and endovascular approaches, which can be performed with coils, coils and stent placement, multiple stents, stent placement alone, or vessel occlusion.…”

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confidence: 99%

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

Peschillo¹,

Cannizzaro

Caporlingua

et al. 2015

American Journal of Neuroradiology

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Blister-like Aneurysms in Atypical Locations: A Single-Center Experience and Comprehensive Literature Review

Cited by 33 publications

References 16 publications

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Pipeline flow diversion of ruptured blister aneurysms of the supraclinoid carotid artery using a single-device strategy

Flow diversion with Pipeline Embolic Device as treatment of subarachnoid hemorrhage secondary to blister aneurysms: dual-center experience and review of the literature

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

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