Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy

Abstract

Endovascular reconstructive treatment of a ruptured BA using a flow-diverting device is a promising strategy that can be performed with acceptable clinical and good radiological results.

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

“…On long-term follow-up angiography the aneurysm was completely obliterated in seven patients. In another case series by Çinar et al 23 the authors reported a series of seven BAs all located in the supraclinoid ICA. In their series, flow diversion with PED was carried out in all but one patient who was treated by parent artery occlusion.…”

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

“…3 Çinar et al published a 7-patient ruptured blister aneurysm series with PED treatment and reported good clinical outcome in 71% and no procedural or postprocedural aneurysm rerupture. 4 A series of 11 ruptured blister aneurysm cases treated with the Silk flow diverter reported good clinical outcomes in 92%, no aneurysmal reruptures, and a procedural minor ischemic stroke in 1 case. 1 A challenging aspect of flow-diversion treatment of ruptured blister aneurysms is the necessity of concomitant dual antiplatelet therapy to minimize the risk of device thrombosis.…”

“…Single device placement occurred in the majority of reported case series; 1,3,4,17,29,31 although aneurysmal rerupture in a patient who had recently undergone flow diversion while receiving dual antiplatelet agents has been reported. 19 Therefore, current practice strategies for ruptured blister aneurysms also include placement of multiple telescoped overlapping flow diverters to minimize the risk of postdiversion rerupture and to speed parent vessel endothelialization and exclusion of the lesion.…”

Early angiographic occlusion of ruptured blister aneurysms of the internal carotid artery using the Pipeline Embolization Device as a primary treatment option

“…The gold standard for the treatment of these lesions has not been established. The outcome from the different endovascular strategies varies in the literature 2 5 9 10. Intraoperative rupture and delayed recurrence remain significant problems using stent-assisted coil embolization 2 5 11–13.…”