Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

Abstract

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

Safety and Efficacy of Endovascular Therapy for Blood Blister-Like Aneurysms: Willis Covered Stents and Double Stents Assistant Coils—A Single Center Cohort Study

“…Despite the lack of a uniform treatment guideline, various interventional treatment strategies have achieved satisfying outcomes, including WCSs, double porous stent-assisted coils, and flow diverters. A former study reported that 76.5% of patients achieved complete aneurysm occlusion and only 9.2% of patients encountered serious complications (12). The use of double porous stent-assisted coils results in higher recurrence and intraoperative rebleeding rates compared with WCSs and flow diverters.…”

Intracranial aneurysms in pediatric population treated with flow diverters: A single-center experience

“…Endovascular management has shown to be safe, effective, and long lasting for this type of aneurysms. [ 39 ] Treatment with FDs in children can be justified due to the great experience globally acquired in adult treatments,[ 6 , 7 , 11 , 22 , 27 ] as well as to the high incidence of giant and fusiform aneurysms on pediatric population, which makes them more susceptible for treatment with these devices. [ 4 ] The treatment with FDs in Mexico was just approved at 2015, and La Raza Medical Center was the first to place one at April, being this a FRED device.…”

Vertebral artery dissection and associated ruptured intracranial pseudoaneurysm successfully treated with coil assisted flow diversion

“…Multiple studies have shown stand-alone FD in the setting of rupture to be associated with a high risk of re-rupture (4%–17%) and increased morbidity and mortality. [ 54 ] The increased incidence of re-rupture is likely secondary to two confounding factors. First, the literature demonstrates only 71% of aneurysms to immediately and completely occlude following FD alone,[ 35 ] leaving residual aneurysm that is prone to rebleeding.…”