Endovascular Treatment Strategy and Clinical Outcomes for Ruptured Blood Blister–Like Aneurysms of the Internal Carotid Artery Using Low-Profile Visualized Intraluminal Support Stent

Aihara, Masanori; Shimizu, Tatsuya; Naito, Isao; Miyamoto, Nobuo; Yamaguchi, Rei; Aishima, Kaoru; Sato, Koji; Shintoku, Ryosuke; Ohtani, Toshiyuki; Okano, Mitsuko; Tsukada, Akihiro; Yoshimoto, Yuhei

doi:10.1016/j.wneu.2021.02.060

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…After title-abstract and full-text screenings (Figure 1: PRISMA flow diagram), 1095 patients from 56 studies 2–8,10–58 underwent EVT for intracranial artery dissections were included in this analysis (Table 1). The publication timeline of included studies 1999 to 2021.…”

Section: Resultsmentioning

confidence: 99%

“…59 Endovascular treatments of IAD have been introduced in the last two decades, which have evolved from simple coiling or balloon occlusion for parent artery sacrifice to more selective and sophisticated reconstructive modalities including overlapping stenting, stent-assisted coiling, and flow diverters. 3,5,11,13,17,20,43 IAD mostly affects the vertebral arteries and rarely the internal carotid arteries. Deconstructive treatments were utilized commonly for vertebrobasilar dissections with good angiographic outcomes, as reported in a previous meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

2022

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Introduction Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. Methods The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. Results Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. Conclusions IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

2022

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“…However, trapping of the ICA carries other untoward consequences, may require bypass, and is difficult if the lesion is located in the ICA segment involving the posterior communicating artery and AChA [18]. Recently, the utilities of a low-profile visualized intraluminal support stent for ICA dissection and BBAs have been reported [18][19][20]. Stent-only technique may be feasible and safe for some uncoilable intracranial aneurysms [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the utilities of a low-profile visualized intraluminal support stent for ICA dissection and BBAs have been reported [18][19][20]. Stent-only technique may be feasible and safe for some uncoilable intracranial aneurysms [19,20].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Magnetic Resonance Contrast-Enhanced Vessel Wall Imaging as an Ancillary Examination for Subarachnoid Hemorrhage With Bleeding Points Difficult to Determine on Conventional Vascular Imaging: A Report of Three Cases

Koketsu¹,

Tanei²,

Kato³

et al. 2022

Cureus

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Here, we have demonstrated the efficacy of magnetic resonance contrast-enhanced vessel wall imaging (CE-VWI) as an ancillary examination for subarachnoid hemorrhage with bleeding points difficult to confirm by conventional vascular imaging. Case 1 had a ruptured small aneurysm with a size of 1.8 × 1.1 mm at the origin of left anterior choroidal artery. CE-VWI showed enhancement of the apex of the aneurysm. Surgical clipping was performed by a mini-clip. In Case 2, a ruptured small aneurysm, 2.1 × 1.9 mm, was detected at right middle cerebral artery bifurcation. CE-VWI showed enhancement of the aneurysmal wall. Endovascular coil embolization was performed. In Case 3, irregular dilatation of left internal carotid artery (ICA) was detected. CE-VWI demonstrated enhancement of the dilatation wall. The lesion was deemed to be a dissection of the ICA or a blood blister-like aneurysm. Endovascular treatment using intracranial stent placement was performed, and the patient has had no rebleeding events for one and a half years. In all cases, conventional vascular imaging detected scanty morphological changes, and CE-VWI information provided reliable confirmation of the lesions as bleeding points.

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“…Various responses to such changes after the initial endovascular treatment include switching to direct trapping with bypass, 3) and additional coiling and/or stenting. 6) …”

Section: Discussionmentioning

confidence: 99%

A Case of Ruptured Anterior Cerebral Artery Dissection Prevented from Re-rupture with Stenting and Modification of Antiplatelet Agents

OTAKI

Shimizu

Aihara

et al. 2021

NMC Case Report Journal

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A case of ruptured anterior cerebral artery (ACA) dissection was treated with multiple neck-bridge stents, with modification of antiplatelet administration according to changes in the shape of the aneurysm in the acute phase. A 67-year-old woman presented with severe subarachnoid hemorrhage and fusiform dilatation was observed in the left ACA between the A1 and A2 segments. The use of stents in the acute phase is associated with high risk of ischemic complications. Prasugrel administration, which is considered to have low drug resistance, may have allowed safe stent use in the acute phase.

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Endovascular Treatment Strategy and Clinical Outcomes for Ruptured Blood Blister–Like Aneurysms of the Internal Carotid Artery Using Low-Profile Visualized Intraluminal Support Stent

Cited by 8 publications

References 22 publications

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

Efficacy of Magnetic Resonance Contrast-Enhanced Vessel Wall Imaging as an Ancillary Examination for Subarachnoid Hemorrhage With Bleeding Points Difficult to Determine on Conventional Vascular Imaging: A Report of Three Cases

A Case of Ruptured Anterior Cerebral Artery Dissection Prevented from Re-rupture with Stenting and Modification of Antiplatelet Agents

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