Treatment of Blood Blister Aneurysms of the Internal Carotid Artery With Pipeline-Assisted Coil Embolization: A Single-Center Experience

Abstract

BackgroundBlood blister aneurysm (BBA) is a complex and rare aneurysm that presents significant treatment challenges. The application of pipeline embolization device (PED)-assisted coiling in the treatment of ruptured BBA remains controversial. This study aimed to report on our experience and assess the safety and efficacy of this strategy.MethodsBetween February 2019 and February 2021, 12 patients with ruptured BBAs underwent PED-assisted coil embolization. We collected detailed data about each patient, including demographic information, aneurysmal data, technical details, antiplatelet strategy, operation-related complications, and follow-up outcomes.ResultsA total of 12 BBA patients were treated with single PED-assisted coil embolization. One patient experienced intraoperative rupture that was controlled by rapid coiling without clinical consequences. All the patients demonstrated complete occlusion on postoperative angiography. A total of three patients had postoperative complications: left hemiparesis, Broca's aphasia, and right hemiplegia due to vasospasm, and transient hemiparesis. Follow-up angiography revealed that all BBAs were completely occluded, except one with neck residue. All patients had favorable outcomes at discharge and the most recent clinical follow-up (mRS score ≤ 2).ConclusionEndovascular treatment of BBAs of the internal carotid artery using PED-assisted coil embolization is a safe and effective strategy. This has contributed to the understanding of BBA therapy and provides a potentially optimal treatment option for this intractable lesion.

Flow Diverter Device-Assisted Coiling Treatment for Cerebral Blister Aneurysm: A Single-Center Study

“…Hence, the parent arteries were re-established simultaneously with the embolization of the BBA. Similarly, Liu and co-workers also reported the successful treatment of single PED-assisted coil embolization in 12 patients with BBAs, in which all patients showed complete occlusion on post-operative angiographies [ 36 ]. Thus, FDDAC may be a viable therapeutic option for cerebral BBAs.…”

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

“…12 Recent retrospective studies have also validated the benefit of this treatment strategy in lowering the risk of perioperative rebleeding. 7,13,14 In addition, the technique of coil packing differs from traditional dense packing in stent-assisted treatment of aneurysms, preferring loose packing (aneurysms and necks) and the use of basket coils with sizes somewhat less than the measurement. 13,15 It allows surgeons not only to reduce the pressure of coils on the aneurysm wall in the process of packing and to avoid excessive tension on the aneurysm wall, but also to further reduce the volume of the aneurysm during follow-up to lessen its occupying effect.…”