The Efficacy of Endovascular Stenting in the Treatment of Supraclinoid Internal Carotid Artery Blister Aneurysms Using a Stent-in-Stent Technique

Gaughen, John R.; Hasan, David; Dumont, Aaron S.; Jensen, Mary E.; McKenzie, J F; Evans, Avery J.

doi:10.3174/ajnr.a2016

Cited by 92 publications

(75 citation statements)

References 21 publications

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“…These 4 subtypes may at times be stages in the evolutionary process, as observed regularly in the clinical setting. 10,29,49 In fact, blister aneurysms are easily missed on the first angiography, where sometimes a questionable bulge can be retrospectively identified. In such cases, a second angiography performed 3 to 14 days later reveals their rapid evolution, making the diagnosis obvious (Table 2) and adding evidence that one may be involved with a continuum.…”

Section: Discussionmentioning

confidence: 99%

“…All aneurysms in our series and those we found in the literature could be readily classified into 1 of these 4 types (Table 2). 1,2,4,6,7,9,10,[12][13][14][18][19][20][23][24][25][26][27][28][29][31][32][33]35,[39][40][41][42][43][44]47,[49][50][51][52]57 Each type presented distinctive surgical pitfalls, which required a different clip placement technique.…”

Section: Blister Aneurysm Classificationmentioning

confidence: 99%

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Morphological aspects of blister aneurysms and nuances for surgical treatment

Bojanowski

Weil

McLaughlin

et al. 2015

JNS

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Blister aneurysms of the internal carotid artery (ICA) arise at a nonbranching site of the dorsal wall of the supraclinoid portion of the ICA. 1,17,30,31,36,38,45,48,53,54 These types of aneurysms are rare and their management remains difficult. Whether the approach to these aneurysms is surgical or endovascular, the literature shows a high mortality and morbidity rate due to their fragile wall with its high rate of rupture during treatment. 28,38,46,48 However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions, thus making different treatment strategies difficult to assess. The first goal of this study was to ascertain whether blister aneurysm morphology played a role in the different pitfalls that may be encountered during surgery, and whether this morphology would require adapted surgical strategies. The second goal was to investigate whether any morphological differences could be categorized into abbreviatioN ICA = internal carotid artery. obJect Blister aneurysms of the supraclinoid part of the internal carotid artery (ICA) are known for their high morbidity and mortality rates related to treatment, regardless of whether the treatment is surgical or endovascular. However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions. The goal of this study was 2-fold: to determine whether different blister aneurysm morphologies present different pitfalls, which would then require different surgical strategies, as well as to determine whether there are identifiable subgroups of these types of aneurysms based on morphology. methods The authors reviewed the charts, cerebral catheter angiograms, surgical reports, and intraoperative videos of all ICA blister aneurysms treated surgically at the Centre Hospitalier de l'Université de Montréal from 2005 to 2012 to investigate whether there was a relationship between morphology and pitfalls, and whether different surgical strategies had been used according to these pitfalls. During this review process the authors noted 4 distinct morphological aspects. These 4 aspects led to a review of the English and French literature on blister aneurysms in which imaging was available, to determine whether other cases could also be classified into the same 4 subgroups based on these morphological aspects. results The retrospective review of the authors' series of 10 patients allowed a division into 4 distinct subtypes: Type I (classic), Type II (berry-like), Type III (longitudinal), and Type IV (circumferential). These subtypes may at times be progressive stages in the arterial anomaly, and could represent a continuum. Each subtype described in this paper presented its own pitfalls and required specific surgical adaptations. Upon reviewing the literature the authors retained 35 studies involving a total of 61 cases of blister aneurysms, and all cases...

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Section: Discussionmentioning

confidence: 99%

Section: Blister Aneurysm Classificationmentioning

confidence: 99%

Morphological aspects of blister aneurysms and nuances for surgical treatment

Bojanowski

Weil

McLaughlin

et al. 2015

JNS

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“…This defect is covered with thin fibrous tissue and adventitia, lacking the usual collagen layer as in classic berry aneurysm. Therefore, these aneurysms have a high risk of intraoperative rupture and not feasible 10,17 . Though our data are limited to a single case, double-stent monotherapy has shown complete occlusion of a BBA.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it is not generally advocated to perform doublestent placement without coiling as a primary treatment option because the likelihood of a residual or a recurrent aneurysm requiring further treatments was reported to be as high as 50% 10 . The principal indication for using stents necked morphology and very weak wall lacking collagenous tissue 4,6 .…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

Sung

et al. 2012

Interv Neuroradiol

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We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

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Blood Blister-Like and Small Aneurysms

Ren

2022

Eight Aneurysms

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The Efficacy of Endovascular Stenting in the Treatment of Supraclinoid Internal Carotid Artery Blister Aneurysms Using a Stent-in-Stent Technique

Cited by 92 publications

References 21 publications

Morphological aspects of blister aneurysms and nuances for surgical treatment

Morphological aspects of blister aneurysms and nuances for surgical treatment

The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

Blood Blister-Like and Small Aneurysms

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