Salvage Surgical Treatment for Failed Endovascular Procedure of a Blood Blister-Like Aneurysm

Cho, Tack Geun; Hwang, Sung Nam; Nam, Taek Kyun; Park, Seung Won

doi:10.7461/jcen.2012.14.2.99

Cited by 15 publications

(16 citation statements)

References 13 publications

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“…Recently, it was reported that the procedure encompassing bypass surgery and ICA trapping (surgical or endovascular) would be an another definitive treatment option for ICA BBAs 2 , 8) . A case similar to ours would be the Cho et al 3) report, which reported a successful case of the use of an encircling clip graft for the treatment of a BBA after endovascular treatment (stent-in-stent technique) had failed. In our case, several attempts of endovascular procedures, such as stent assisted coil embolization, repeated coil embolization for recanalized aneurysm failed to prevent aneurysmal enlargement or reduce the risk of rebleeding of the fragile aneurysm.…”

Section: Discussionsupporting

confidence: 73%

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Cho

2014

J Korean Neurosurg Soc

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Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).

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Section: Discussionsupporting

confidence: 73%

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Cho

2014

J Korean Neurosurg Soc

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“…They achieved good outcomes in 76 % of patients, most of whom were treated for blister aneurysms [22]. Sundt clip grafts have also been successfully applied as a salvage operation after failed endoluminal stenting [23], and their application remains an important tool in the arsenal of surgical treatment techniques for selected patients. However, the encircling clip grafts have important limitations when it comes to the anatomy of the vessel segment around which they are to be applied.…”

Section: Surgical Treatmentmentioning

confidence: 98%

Blister Aneurysms

Byrne¹,

Mørkve²

2014

Neurovascular Imaging

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Blister aneurysms comprise about 1 % of ruptured intracranial aneurysms. They are associated with higher rates of rebleeding and, as a result, with greater mortality and morbidity than typical aneurysms. Because of rarity, the etiology and pathology are poorly understood. Diagnosis relies on a stereotypical appearance and location at non-branch points on the internal carotid artery at angiography, together with inspection at surgery. They are increasingly seen involving other intracranial arteries and generally considered to be caused by atherosclerotic mural disease.Surgical clipping is difficult because of their small size, sessile shape, and thin sac walls. It is frequently complicated by operative rupture, and alternative wrapping and trapping are often required. For these reasons, endovascular treatments are increasingly used as an alternative. The recent introduction of high mesh density stents, designed to redirect blood flow away from aneurysms and reinforce the parent artery, has stimulated the development of new procedures to manage these lesions. Initial experiences with flow-diverting stents have shown a substantial improvement in outcomes, and stent procedures are rapidly being accepted as the intervention of choice.

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“…Meling TR et al, 2008 (23) state that endovascular coiling of BBAs of the ICA cannot be recommended due to the high rates of procedural rupture (75%), aneurysm regrowth, and rebleeding. Cho et al, 2012 (24) also debate about the aneurysm regrowth in a case report after coil embolization, saying that surgery is a useful treatment modality for fragile aneurysm. Furthermore, Peschillo et al, 2016 (8) in a meta-analysis states that patients in Hunt and Hess (HH) > 3 had better outcomes when treated with surgery.…”

Section: Treatment Of Blister-like Aneurysmmentioning

confidence: 99%

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

Aguiar

Santos

et al. 2019

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introduction: Blister aneurysms are of uncertain pathogenesis and are a vascular lesion located in the brain. Overall, they represent 0.3% - 1.0% of all intracranial aneurysms and 0.9% - 6.5% of ruptured intracranial aneurysms. They are associated with high morbidity and mortality. Even with the first description being from 1969, there is still debate in the literature about which type of treatment is the best: surgical or endovascular. In this review, we focus on the surgical management. Method: The authors performed a review of available surgical techniques used for blood blister-like aneurysms treatment. Pubmed database was used as search source introducing blister-like aneurysm and blister aneurysms as keywords. The most relevant articles and those that focused on surgical treatment techniques were selected. Discussion: The most used surgical methods are clipping, trapping, wrapping and bypass. As main features of each technique, we can highlight clipping with good efficiency, when there is good neck exposure; trapping being employed in ruptured aneurysm; wrapping for avulsion and bypass that promotes vascularization to the distal territory of the aneurysm. Conclusion: The endovascular method has shown to be promising and efficient. However, different surgical techniques are still being employed based on their efficiency when facing certain surgical scenarios.Keywords: Neurosurgery, Subarachnoid hemorrhage, Intracranial aneurysm, Endovascular proceduresRESUMOIntrodução: Aneurismas cerebrais blister-like são lesões vasculares de patogenia incerta. De modo geral, representam 0.3%-1.0% de todos aneurismas intracranianos e 0.9% - 6.5% dos aneurismas intracranianos que rompem. Estão associados a alta morbimortalidade. Mesmo com a primeira descrição sendo de 1969, ainda há debate na literatura sobre qual tipo de tratamento é o melhor: cirúrgico ou endovascular. Nessa revisão, focamos no tratamento cirúrgico. Métodos: Os autores realizaram uma revisão das técnicas cirúrgicas utilizadas para tratamento de aneurismas blister-like. A plataforma Pubmed foi utilizada para a pesquisa das palavras chaves “blister-like aneurysm” e “blister aneurysm”. Os artigos de maior relevância e aqueles que enfatizam as técnicas cirúrgicas foram selecionados. Discussão: Os métodos cirúrgicos empregados são clipagem, trapping, wrapping e bypass. Quanto às características de cada método, podemos salientar a eficácia da clipagem, quanto melhor for a exposição do aneurisma; o uso do trapping em situações de rompimento do aneurisma; wrapping para casos em que houve avulsão do aneurisma e by-pass que promove a vascularização distal ao aneurisma. Conclusão: O método endovascular tem se mostrado promissor e efetivo. No entanto, as diferentes técnicas cirúrgicas ainda são empregadas e defendidas devido a sua eficiência frente certos cenários cirúrgicos.Descritores: Neurocirurgia, Hemorragia subaracnóidea, Aneurisma intracraniano, Procedimentos endovasculares

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Salvage Surgical Treatment for Failed Endovascular Procedure of a Blood Blister-Like Aneurysm

Cited by 15 publications

References 13 publications

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Blister Aneurysms

Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

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