Endovascular treatment of blood blister–like aneurysms of the internal carotid artery

Park, Jae Hyo; Park, In Sung; Han, Dae Hee; Kim, Seong Hyun; Oh, Chang Wan; Kim, Jeongeun; Kim, Hyun Jib; Han, Moon Hee; Kwon, O-Ki

doi:10.3171/jns.2007.106.5.812

Cited by 149 publications

(155 citation statements)

References 13 publications

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“…There are a number of articles outlining the treatment of acutely ruptured wide-neck 21,22 or acute blister aneurysms [23][24][25] with stents and/or coils, for which coil placement is difficult or impossible. Tahtinen et al 21 treated 61 patients with wide-neck aneurysms (including 3 vertebral dissections) within 72 hours of the onset of SAH by using Neuroform stents (Boston Scientific, Natick, Massachusetts) and coils.…”

Section: Discussionmentioning

confidence: 99%

Immediate and Midterm Results following Treatment of Recently Ruptured Intracranial Aneurysms with the Pipeline Embolization Device

McAuliffe¹,

Wenderoth²

2011

AJNR Am J Neuroradiol

114

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Section: Discussionmentioning

confidence: 99%

Immediate and Midterm Results following Treatment of Recently Ruptured Intracranial Aneurysms with the Pipeline Embolization Device

McAuliffe¹,

Wenderoth²

2011

AJNR Am J Neuroradiol

114

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“…1,2,8,10-12,14-16) Some aneurysms of the dorsal ICA may have a normal aneurysm wall and can be clipped at the neck. 3,12) However, only accessing the aneurysm for observation can result in massive hemorrhage. If the aneurysm can be clipped, the ECA-RA-MCA bypass does not disturb the clipping procedure at all.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of many kinds of treatment modalities, the results have been unsatisfactory, because many treatments did not target the pathological ICA segment but the BBA itself. In a paper from our institute, 3) all patients eventually underwent ICA trapping because of regrowth and rebleeding. Thus, trapping of the ICA segment with or without extracranial-intracranial (EC-IC) bypass is thought the best treatment of choice.…”

Section: Department Of Neurosurgerymentioning

confidence: 99%

Universal External Carotid Artery to Proximal Middle Cerebral Artery Bypass With Interposed Radial Artery Graft Prior to Approaching Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery -Technical Note-

Ishikawa

Mutoh

Nakayama

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Blood blister-like aneurysms are dangerous aneurysms with fragile walls arising from the supraclinoid internal carotid artery (ICA). Primary treatment of these aneurysms in the acute stage is challenging, due to the substantial risk of periprocedural bleeding. We describe a series of 4 patients who presented with ruptured blister-like aneurysm of the ICA and were treated with completion of extracranial-intracranial high-flow bypass followed by inspection and trapping of the aneurysm. All patients were treated in the acute stage, within 48 hours of bleeding. External carotid artery to proximal middle cerebral artery bypass with interposed radial artery (RA) graft was established followed by approach to the lesion and trapping of the parent vessels. The aneurysms in 3 patients ruptured during dissection of the lesion from the surrounding structures, but bleeding was easily controlled. RA grafts were patent in all patients and no postoperative symptomatic ischemic or hemorrhagic complications were encountered, resulting in excellent outcomes with modified Rankin scale scores of 0 at follow up after 3 months. Our present strategy for surgical treatment of blister-like aneurysms completely avoided the risk of devastating intraoperative hemorrhage, offering a most cautious strategy associated with minimal risk of intraoperative massive bleeding.Key words: blister-like aneurysm, internal carotid artery, trapping, subarachnoid hemorrhage, external carotid artery to proximal middle cerebral artery bypass with interposed radial artery graft

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“…As for endovascular techniques, coil embolization of blister aneurysms also remains problematic and not suitable because of its associated risk of rupture and ischemia. 29,42 The use of flow diversion devices, such as the Pipeline (Covidien) and SILK (Balt Extrusion) devices, has been deemed a technically safe and feasible alternative. 3,5,8,15,26,37,56 However, the aneurysm is not always immediately occluded, leading to the potential risk of rebleeding.…”

Section: Clipping Techniquesmentioning

confidence: 99%

“…All aneurysms in our series and those we found in the literature could be readily classified into 1 of these 4 types (Table 2). 1,2,4,6,7,9,10,[12][13][14][18][19][20][23][24][25][26][27][28][29][31][32][33]35,[39][40][41][42][43][44]47,[49][50][51][52]57 Each type presented distinctive surgical pitfalls, which required a different clip placement technique.…”

Section: Blister Aneurysm Classificationmentioning

confidence: 99%

Morphological aspects of blister aneurysms and nuances for surgical treatment

Bojanowski

Weil

McLaughlin

et al. 2015

JNS

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Blister aneurysms of the internal carotid artery (ICA) arise at a nonbranching site of the dorsal wall of the supraclinoid portion of the ICA. 1,17,30,31,36,38,45,48,53,54 These types of aneurysms are rare and their management remains difficult. Whether the approach to these aneurysms is surgical or endovascular, the literature shows a high mortality and morbidity rate due to their fragile wall with its high rate of rupture during treatment. 28,38,46,48 However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions, thus making different treatment strategies difficult to assess. The first goal of this study was to ascertain whether blister aneurysm morphology played a role in the different pitfalls that may be encountered during surgery, and whether this morphology would require adapted surgical strategies. The second goal was to investigate whether any morphological differences could be categorized into abbreviatioN ICA = internal carotid artery. obJect Blister aneurysms of the supraclinoid part of the internal carotid artery (ICA) are known for their high morbidity and mortality rates related to treatment, regardless of whether the treatment is surgical or endovascular. However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions. The goal of this study was 2-fold: to determine whether different blister aneurysm morphologies present different pitfalls, which would then require different surgical strategies, as well as to determine whether there are identifiable subgroups of these types of aneurysms based on morphology. methods The authors reviewed the charts, cerebral catheter angiograms, surgical reports, and intraoperative videos of all ICA blister aneurysms treated surgically at the Centre Hospitalier de l'Université de Montréal from 2005 to 2012 to investigate whether there was a relationship between morphology and pitfalls, and whether different surgical strategies had been used according to these pitfalls. During this review process the authors noted 4 distinct morphological aspects. These 4 aspects led to a review of the English and French literature on blister aneurysms in which imaging was available, to determine whether other cases could also be classified into the same 4 subgroups based on these morphological aspects. results The retrospective review of the authors' series of 10 patients allowed a division into 4 distinct subtypes: Type I (classic), Type II (berry-like), Type III (longitudinal), and Type IV (circumferential). These subtypes may at times be progressive stages in the arterial anomaly, and could represent a continuum. Each subtype described in this paper presented its own pitfalls and required specific surgical adaptations. Upon reviewing the literature the authors retained 35 studies involving a total of 61 cases of blister aneurysms, and all cases...

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Endovascular treatment of blood blister–like aneurysms of the internal carotid artery

Cited by 149 publications

References 13 publications

Immediate and Midterm Results following Treatment of Recently Ruptured Intracranial Aneurysms with the Pipeline Embolization Device

Immediate and Midterm Results following Treatment of Recently Ruptured Intracranial Aneurysms with the Pipeline Embolization Device

Universal External Carotid Artery to Proximal Middle Cerebral Artery Bypass With Interposed Radial Artery Graft Prior to Approaching Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery -Technical Note-

Morphological aspects of blister aneurysms and nuances for surgical treatment

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