Document Detail


Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery.
MedLine Citation:
PMID:  19046039     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. METHODS: Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. RESULTS: All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. CONCLUSIONS: In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.
Authors:
Byung-Hee Lee; Byung Moon Kim; Moon Sun Park; Sung Il Park; Eun Chul Chung; Sang Hyun Suh; Chun Sik Choi; Yu Sam Won; In Kyu Yu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  110     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-02     Completed Date:  2009-04-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-6     Citation Subset:  AIM; IM    
Affiliation:
Departments of Radiology, Eulji University Hospital, Daejeon, Seoul, Republic of Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aneurysm, Ruptured / radiography,  therapy*
Carotid Artery Diseases / radiography,  surgery*
Carotid Artery, Internal*
Cerebral Angiography
Embolization, Therapeutic / methods
Equipment Design
Female
Humans
Intracranial Aneurysm / radiography,  therapy*
Male
Middle Aged
Retrospective Studies
Stents*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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