Contemporary Treatment of Intracranial Blood Blister Aneurysms – A Systematic Review

Nasra, Mohamed; Mitreski, Goran; Kok, Hong Kuan; Maingard, Julian; Slater, Lee-Ann; Russell, Jeremy; Hall, Jonathan; Chong, Winston; Jhamb, Ashu; Brooks, Duncan Mark; Asadi, Hamed

doi:10.1016/j.jstrokecerebrovasdis.2021.105968

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…Currently, the natural history of BBA is uncertain [ 26 ], and small sample sizes and substantial study heterogeneity make strong conclusions difficult [ 22 ], so the optimal timing of treatment for BBA is still uncertain. A study compared the impact of different surgical timings on patient prognosis, and the results showed that there was no significant difference between early surgery and delayed elective surgery [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study

Huang,

Ren,

Liu

et al. 2024

J Korean Neurosurg Soc

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Objective : Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population.Methods : The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed.Results : A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin scale, 0–2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events.Conclusion : In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.

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Section: Discussionmentioning

confidence: 99%

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study

Huang,

Ren,

Liu

et al. 2024

J Korean Neurosurg Soc

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“…Although the efficacy of microsurgical, interventional, and combined methods for BBAs have been demonstrated, no one-fit-all solution exists ( 10 – 16 ). Successful microsurgical treatment of BBA has been demonstrated, including clipping, wrap-clipping, suturing, and extracranial-intracranial bypass ( 4 , 17 ). Wrap-clipping, in comparison to wrapping and clipping, has been shown in several studies with low recurrence and re-rupture rates ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Liu

Zhang

et al. 2022

Front. Neurol.

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BackgroundBlood blister aneurysm (BBA) is a complex and rare aneurysm that presents significant treatment challenges. The application of pipeline embolization device (PED)-assisted coiling in the treatment of ruptured BBA remains controversial. This study aimed to report on our experience and assess the safety and efficacy of this strategy.MethodsBetween February 2019 and February 2021, 12 patients with ruptured BBAs underwent PED-assisted coil embolization. We collected detailed data about each patient, including demographic information, aneurysmal data, technical details, antiplatelet strategy, operation-related complications, and follow-up outcomes.ResultsA total of 12 BBA patients were treated with single PED-assisted coil embolization. One patient experienced intraoperative rupture that was controlled by rapid coiling without clinical consequences. All the patients demonstrated complete occlusion on postoperative angiography. A total of three patients had postoperative complications: left hemiparesis, Broca's aphasia, and right hemiplegia due to vasospasm, and transient hemiparesis. Follow-up angiography revealed that all BBAs were completely occluded, except one with neck residue. All patients had favorable outcomes at discharge and the most recent clinical follow-up (mRS score ≤ 2).ConclusionEndovascular treatment of BBAs of the internal carotid artery using PED-assisted coil embolization is a safe and effective strategy. This has contributed to the understanding of BBA therapy and provides a potentially optimal treatment option for this intractable lesion.

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“…[ 23 , 29 ] Overall, endovascular treatment produces a higher percentage of favorable outcomes with modified Rankin scale (mRS) 0–2 when compared to microsurgical intervention due to lower perioperative morbidity and mortality. [ 17 , 22 , 24 ] The main disadvantage of endovascular treatment is a lower immediate occlusion rate. [ 23 , 28 ] Most lesions will require more than one stent to potentiate aneurysm occlusion and often require extended time to achieve occlusion, as long as 13.6 months.…”

Section: Introductionmentioning

confidence: 99%

Periprocedural management of ruptured blister aneurysms treated with pipeline flow diversion

Hoffman,

Morel,

Wittenberg

et al. 2024

Surgical Neurology International

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Background: Blister aneurysms are high-risk intracranial vascular lesions. Definitive treatment of these lesions has been challenging. Severe disability or mortality rates are as high as 55% when these lesions are treated with open surgery. Recent data show that flow diversion is a safe and effective alternative treatment for blister aneurysms. Rerupture of the functionally unsecured lesion remains a concern as flow diversion does not immediately exclude the aneurysm from the circulation. Methods: A retrospective review was performed of any patients with ruptured blister aneurysms treated with a pipeline embolization device between 2010 and 2020 at the University of Colorado. Results: In this paper, we present the results of the intensive care management of ruptured intracranial blister aneurysms after flow-diverting stent placement. Conclusion: Despite the need for dual antiplatelet therapy and the delayed occlusion of blister aneurysms treated with flow diversion, we did not find an increase in periprocedural complications.

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Contemporary Treatment of Intracranial Blood Blister Aneurysms – A Systematic Review

Cited by 5 publications

References 40 publications

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study

Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Periprocedural management of ruptured blister aneurysms treated with pipeline flow diversion

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