Rupture of symptomatic blood blister-like aneurysm of the internal carotid artery: clinical experience and management outcome

Liu, Yu-Tse; Wong, Ho-Fai; Lee, Cheng‐Chi; Chu-Mei, Ku; Wang, Alvin Yi-Chou; Yang, Tao-Chieh

doi:10.3109/02688697.2011.631617

Cited by 33 publications

(10 citation statements)

References 19 publications

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“…11 Endovascular surgery has achieved favorable outcomes in a small number of select patients. [33][34][35][36] Although intraoperative bleeding and the resultant mortality rate are extremely high in the ultra-early phase, delayed surgery achieved a 72% favorable outcome as per data from a nationwide survey. 10 Therefore, the timing of surgery may play a major role in improving the outcomes of treatment for BBAs.…”

Section: Discussionmentioning

confidence: 91%

Changing Treatment Strategy From Clipping to Radial Artery Graft Bypass and Parent Artery Sacrifice in Patients With Ruptured Blister-Like Internal Carotid Artery Aneurysms

Kazumata

Nakayama

Nakamura

et al. 2014

Operative Neurosurgery

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Section: Discussionmentioning

confidence: 91%

Changing Treatment Strategy From Clipping to Radial Artery Graft Bypass and Parent Artery Sacrifice in Patients With Ruptured Blister-Like Internal Carotid Artery Aneurysms

Kazumata

Nakayama

Nakamura

et al. 2014

Operative Neurosurgery

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“…Eighteen studies evaluated endovascular therapy only, 14 evaluated surgery only, and 4 included both endovascular and surgical interventions. 3,35,39,52 For our analysis, 22 and 18 papers were examined and analyzed for endovascular and surgical approaches, respectively.…”

Section: Study Characteristics and Designsmentioning

confidence: 99%

Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy

Shah

Gersey

Nuh

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) have a poor natural history associated with high morbidity and mortality. Currently, both surgical and endovascular techniques are employed to treat BBAs; thus, the authors sought to perform a meta-analysis to compare the efficacy and safety of these approaches. METHODS A literature search of PubMed, MEDLINE, and Google Scholar online databases was performed to include pertinent English-language studies from 2005 to 2015 that discussed the efficacy and safety of either surgical or endovascular therapies to treat BBAs. RESULTS Thirty-six papers describing 256 patients with BBAs treated endovascularly (122 procedures) or surgically (139 procedures) were examined for data related to therapeutic efficacy and safety. Pooled analysis of 9 papers demonstrated immediate and late (mean 20.9 months) aneurysm occlusion rates of 88.9% (95% CI 77.6%-94.8%) and 88.4% (95% CI 76.7%-94.6%), respectively, in surgically treated patients. Pooled analysis of 12 papers revealed immediate and late aneurysm obliteration rates of 63.9% (95% CI 52.3%-74.1%) and 75.9% (95% CI 65.9%-83.7%), respectively, in endovascularly treated aneurysms. Procedure-related complications and overall poor neurological outcomes were slightly greater in the surgically treated cases than in the endovascularly treated cases (27.8% [95% CI 19.6%-37.8%] vs 26.2% [95% CI 18.4%-35.8%]), indicating that endovascular therapy may provide better outcomes. CONCLUSIONS Blood-blister aneurysms are rare, challenging lesions with a poor prognosis. Although surgical management potentially offers superior aneurysm obliteration rates immediately after treatment and at the long-term follow-up, endovascular therapy may have a better safety profile and provide better functional outcomes than surgery. A registry of patients treated for BBAs may be warranted to better document the natural course of the disease as well as treatment outcomes.

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“…There are 2 approaches to treat BBAs, such as endovascular or direct surgery (Table 2). 7, 18, 22, 35 The number of reports using the endovascular method have been increasing because of the recent improvement of medical equipment such as a flow diverter 11, 15, 16, 17, 19, 20, 21, 36, 37, 38, 39, 40, 41, 42, 43. Previous studies comparing the 2 approaches found higher risk in the direct surgeries including accidental IC occlusions, albeit higher recurrence rate and more frequent reoperation in the endovascular treatment 18, 22, 37, 44, 45, 46.…”

Section: Discussionmentioning

confidence: 99%

Clipping on Crossed Wrapping Method for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: Technical Note and Long-Term Results

Nishi

Kaji

Koga³

et al. 2019

World Neurosurgery: X

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Background We have been performing the clipping on crossed wrapping (COCW) method using 2 strips of cotton on patients with an internal carotid artery blood blister-like aneurysm (IC-BLA). This method is reliable in preventing the clips from slipping off and the aneurysm walls from being damaged during clipping, and it enables more appropriate and safer clipping. Here we report the technical details of this method and the long-term outcomes of patients receiving this procedure. Methods Fifteen of 1275 (1.5%) patients with a ruptured cerebral aneurysm who received treatment at the Saiseikai Kumamoto Hospital during the period from January 1, 1999, to December 31, 2016, had an IC-BLA. All 15 patients were treated with COCW, except for the first patient, who was treated using a single strip of cotton. The long-term outcome of the treatment was analyzed. Results The mean follow-up period was 74 months. The first patient experienced rerupture of an aneurysm 10 days after the operation. No complications or regrowth of an aneurysm were observed in the remaining 14 patients during the follow-up period, except for 1 patient who received a reoperation for the regrowth of an aneurysm. As the final outcome, the numbers of patients with a Modified Rankin Score of 0, 3, and 6 were 13, 1, and 1, respectively. Conclusions It is suggested that COCW is a treatment that enables safe and long-term management of lesions in IC-BLAs.

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Rupture of symptomatic blood blister-like aneurysm of the internal carotid artery: clinical experience and management outcome

Cited by 33 publications

References 19 publications

Changing Treatment Strategy From Clipping to Radial Artery Graft Bypass and Parent Artery Sacrifice in Patients With Ruptured Blister-Like Internal Carotid Artery Aneurysms

Changing Treatment Strategy From Clipping to Radial Artery Graft Bypass and Parent Artery Sacrifice in Patients With Ruptured Blister-Like Internal Carotid Artery Aneurysms

Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy

Clipping on Crossed Wrapping Method for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: Technical Note and Long-Term Results

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