Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: A single-centre experience and literature review

Yang, Chen; Vadász, Ágnes; Szikora, István

doi:10.1177/1591019917720805

Cited by 26 publications

(23 citation statements)

References 51 publications

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“…The primary goal of early intervention is to prevent rebleeding. Although we did not find a significant difference in rebleed rates between aneurysms treated with or without additional coiling, Yang et al showed that adjunctive use of coiling achieves a higher incidence of immediate complete occlusion of blister-like aneurysms 26. However, Mokin et al found no difference in complete (blood blister-like) aneurysm occlusion regarding the use of adjunctive coiling 29.…”

Section: Discussioncontrasting

confidence: 71%

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Flow diversion treatment for acutely ruptured aneurysms

Brinck

Jäger

Vries

et al. 2019

J NeuroIntervent Surg

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Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.

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Section: Discussioncontrasting

confidence: 71%

“…Several other series (not in the meta-analysis) investigating FD treatment in the acute SAH phase have been published 9 10 13 19 23–27. The pooled favorable clinical outcome (mRS 0–2) rate of these studies was 71% (range 27–92%) (57/80).…”

Section: Discussionmentioning

confidence: 99%

Flow diversion treatment for acutely ruptured aneurysms

Brinck

Jäger

Vries

et al. 2019

J NeuroIntervent Surg

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“…However, FDDs also have the disadvantages of a low initial obliteration rate and early rebleeding. Adjunctive use of coiling can achieve a higher incidence of immediate occlusion of BLAs [ 22 ]. Moreover, dual anti-platelet therapy is another challenging factor for the use of FDDs in the acute phase of aSAH.…”

Section: Discussionmentioning

confidence: 99%

Supraclinoid internal carotid artery blister-like aneurysms: hypothesized pathogenesis and microsurgical clipping outcomes

Chen

Niu

et al. 2021

Chin Neurosurg Jl

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Background Blister-like aneurysms (BLAs) on the supraclinoid segment of the internal carotid artery (ICA) are an enigma of cerebrovascular disease. Neither has a definite pathogenesis been so far identified, nor have uniform treatment guidelines been established for them. Our aim was to develop a hypothesis regarding the evolution of BLAs according to their macroscopic morphologies and to evaluate the efficacy of microsurgical clipping. Methods The clinical data and morphological features of 15 consecutive patients with 16 BLAs on the supraclinoid ICA were retrospectively reviewed. The treatment strategies were analyzed, and functional outcomes were evaluated using the modified Rankin scale (mRS). Favorable outcomes were defined as a mRS score of 0–2. Results Morphologically, aneurysm growth with expansion of the aneurysm neck before the surgical procedure occurred in two ruptured and one unruptured aneurysm. Daughter bleb formation was observed in two ruptured and five unruptured aneurysms. A varied degree of parent artery sclerosis was observed in nine patients. Thirteen patients were treated with direct surgical clipping, one patient was treated with clipping and wrapping, and the remaining patient was treated with an encircling clipping graft. Favorable and unfavorable outcomes were observed in 13 and two cases, respectively. Follow-up angiograms revealed 4 cases of stenosis with respective degree of mild, 30%, 50%, and 80% without any neurological dysfunction. Conclusions We suggest a hypothesis that BLAs on the supraclinoid ICA may share different evolving mechanisms between ruptured and unruptured lesions. A majority of them can be reliably and safely obliterated by direct clipping technique, except for the aneurysms accompanied with severely atherosclerotic parent walls.

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“…Several EVT, microsurgical and hybrid treatment approaches have been published although there is still no consensus on the optimal treatment strategy. [1][2][3][4][5]7,11,[20][21][22][23] Endovascular options can be categorized as either deconstructive (e.g. PVO) or reconstructive (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of these lesions is complicated and various treatment approaches, both endovascular and microsurgical, have been proposed. [1][2][3][4][5][6][7][8][9][10][11][12] Despite significant progress in endovascular and microsurgical treatment, no reliable management strategy has been established so far.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical clipping and endovascular flow diversion of ruptured anterior circulation blood blister-like aneurysms

et al. 2018

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Background Detection and treatment of blister-like intracranial aneurysms as a source of subarachnoid hemorrhage (SAH) can be challenging. In the past the results of both microsurgical and endovascular treatment were difficult. We present our experience with the treatment of blister-like aneurysms in the acute phase of SAH using microsurgical clipping, endovascular parent vessel occlusion or flow diversion. Methods A retrospective analysis of the cases of eight consecutive patients presenting in the acute phase after SAH from an intracranial blister aneurysm was performed. The demographic data of the patients, aneurysm characteristics, the clinical results of the treatment and the follow-up examinations were recorded. Procedural safety margins and aneurysm occlusion on follow-up digital subtraction angiography were the main interest of this evaluation. Results Between January 2012 and November 2017 a total of eight ruptured blister aneurysms were treated in our center, six patients endovascularly. Five patients were treated in the acute phase of SAH, four by flow diversion. All endovascular procedures were feasible and no procedure-related complications were observed, especially no recurrent hemorrhage. In the first angiographic follow-up all blood blister-like aneurysms were completely occluded; two of the six patients treated by flow diverter implantation showed mild, transient intimal hyperplasia without clinical symptoms or the need for treatment. Conclusions Endovascular flow diversion is a viable option in the acute phase after SAH due to the rupture of a blister aneurysm. Implants with reduced thrombogenicity, obviating dual-platelet function inhibition, and flow diverters for vessel bifurcations would extend the indications for this treatment modality.

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Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: A single-centre experience and literature review

Cited by 26 publications

References 51 publications

Flow diversion treatment for acutely ruptured aneurysms

Flow diversion treatment for acutely ruptured aneurysms

Supraclinoid internal carotid artery blister-like aneurysms: hypothesized pathogenesis and microsurgical clipping outcomes

Microsurgical clipping and endovascular flow diversion of ruptured anterior circulation blood blister-like aneurysms

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