J Korean Neurosurg Soc.  2021 Mar;64(2):217-228. 10.3340/jkns.2020.0174.

Is Stent-Assisted Coil Embolization for the Treatment of Ruptured Blood Blister-Like Aneurysms of the Supraclinoid Internal Carotid Artery Effective? : An Analysis of Single Institutional Experience with Pooled Data

Affiliations
  • 1Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 2Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, Korea

Abstract


Objective
: Given the high risk of rebleeding and recurrence of blood blister-like aneurysms (BBAs), we treated ruptured BBAs of the internal carotid artery (ICA) with stent-assisted coil embolization (SAC). This study aimed to evaluate the efficacy and safety of SACs.
Methods
: We retrospectively reviewed clinical and radiological data from eight patients with ruptured BBAs of the supraclinoid ICA. The modified Rankin Scale (mRS) was used to assess clinical outcomes, while radiological outcomes were evaluated on angiographs. For a pooled analysis, data from literature reporting the outcomes of ruptured BBAs treated with SAC were collected and analyzed in conjunction with our data.
Results
: In our cohort, the mean Raymond classification score was 1.57±0.53 immediately after initial endovascular treatment. There were no perioperative complications or rebleeding events during the follow-up period. The mean mRS score at patient discharge was 1.00±0.81 and improved to 0.28±0.48 by the last follow-up day. The recurrence rate was 25% with an asymptomatic presentation and successful treatment with multiple stent insertion. Pooled analysis of 76 cases of SAC revealed a complete occlusion rate immediately after treatment of 54.8%, rebleeding rate 7.94%, and recurrence rate 24.2%. Good clinical outcomes with mRS score 0–2 were observed in 89.9% by the last clinical follow-up. Total mortality rate was 7.7%.
Conclusion
: This treatment appears to not only minimize the hemodynamic burden on the fragile dome specific to this type of aneurysm, but also provides an opportunity for safe and effective treatment in recurrent cases.

Keyword

Aneurysm, Blister-like; Embolization; Stent; Supraclinoid internal carotid artery

Figure

  • Fig. 1. The literature selection process for the pooled analysis of SAC in the treatment of ruptured blood blister-like aneurysms. SAC : stentassisted coil embolization.

  • Fig. 2. Digital subtraction angiography (DSA) images of case 8. DSA revealed a ruptured aneurysm at the communicating segment of the right supraclinoid internal carotid artery (A and B). A Raymond classification score of 2 was achieved immediately after treatment (C). Follow-up angiography 1 year after initial treatment showed complete occlusion of the treated aneurysm (D).

  • Fig. 3. Digital subtraction angiography images of case 3. DSA revealed a ruptured aneurysm with a relatively wide neck (3.1 mm) and short height (2.3 mm) (A). A single Enterprise stent was inserted for neck remodeling and three coils were packed into the aneurysmal sac. A Raymond classification of 2 was achieved (B). Six months after the initial endovascular treatment, asymptomatic recurrence of the treated blood blister-like aneurysm was observed (C and D). After retreatment, gradual improvement and, eventually, complete angiographic cure of the recurred aneurysm was observed in the followup serial DSA studies (E and F). DSA : digital subtraction angiography.

  • Fig. 4. Forest plot summarizing the pooled analysis of stent-assisted coil embolization for ruptured BBAs from the literature. f/u : follow-up, mRS : modified Rankin Scale, SAC : stent-assisted coil embolization, BBAs : blood blister-like aneurysms.


Reference

References

1. Cerejo R, Bain M, John S, Hardman J, Moore N, Hussain MS, et al. Flow diverter treatment of cerebral blister aneurysms. Neuroradiology. 59:1285–1290. 2017.
Article
2. Fang YB, Li Q, Wu YN, Zhang Q, Yang PF, Zhao WY, et al. Overlapping stents for blood blister-like aneurysms of the internal carotid artery. Clin Neurol Neurosurg. 123:34–39. 2014.
Article
3. Gaughen JR Jr, Hasan D, Dumont AS, Jensen ME, McKenzie J, Evans AJ. The efficacy of endovascular stenting in the treatment of supraclinoid internal carotid artery blister aneurysms using a stent-in-stent technique. AJNR Am J Neuroradiol. 31:1132–1138. 2010.
Article
4. Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, et al. Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol. 83:197–205. 2014.
Article
5. Hao X, Li G, Ren J, Li J, He C, Zhang HQ. Endovascular patch embolization for blood blister-like aneurysms in dorsal segment of internal carotid artery. World Neurosurg. 113:26–32. 2018.
Article
6. Ihn YK, Kim SH, Sung JH, Kim TG. The efficacy of endovascular treatment of ruptured blood blister-like aneurysms using stent-assisted coil embolization. Interv Neuroradiol. 18:432–441. 2012.
Article
7. Ishikawa T, Nakamura N, Houkin K, Nomura M. Pathological consideration of a “blister-like” aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery. 40:403–405. discussion 405-406. 1997.
Article
8. Kim BM, Chung EC, Park SI, Choi CS, Won YS. Treatment of blood blister-like aneurysm of the internal carotid artery with stent-assisted coil embolization followed by stent-within-a-stent technique. Case report. J Neurosurg. 107:1211–1213. 2007.
Article
9. Kim YW, Park IS, Baik MW, Jo KW. Endovascular treatment of blood blister-like aneurysms using multiple self-expanding stents. J Korean Neurosurg Soc. 49:116–119. 2011.
Article
10. Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH, et al. Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. J Neurosurg. 110:431–436. 2009.
Article
11. Lim YC, Kim BM, Suh SH, Jeon P, Kim SH, Ihn YK, et al. Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil. Neurosurgery. 73:480–488. 2013.
Article
12. Matsubara N, Miyachi S, Tsukamoto N, Izumi T, Naito T, Haraguchi K, et al. Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery. Acta Neurochir (Wien). 153:287–294. 2011.
Article
13. Meckel S, Singh TP, Undrén P, Ramgren B, Nilsson OG, Phatouros C, et al. Endovascular treatment using predominantly stent-assisted coil embolization and antiplatelet and anticoagulation management of ruptured blood blister-like aneurysms. AJNR Am J Neuroradiol. 32:764–771. 2011.
Article
14. Meling TR, Sorteberg A, Bakke SJ, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg. 108:662–671. 2008.
Article
15. Mizutani T, Miki Y, Kojima H, Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery. 45:253–259. discussion 259-260. 1999.
Article
16. Nagasaki H, Narikiyo M, Nagayama G, Nagao S, Tsuboi Y, Kambayashi C. Hybrid procedure combining clip on wrapping and stent placement for ruptured supraclinoid blood blister-like aneurysm of the internal carotid artery. Clin Case Rep. 5:285–289. 2017.
Article
17. Peschillo S, Cannizzaro D, Caporlingua A, Missori P. A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms. AJNR Am J Neuroradiol. 37:856–861. 2016.
Article
18. Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF. Endovascular treatment of ruptured blister-like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. AJNR Am J Neuroradiol. 36:2331–2339. 2015.
Article
19. Shah SS, Gersey ZC, Nuh M, Ghonim HT, Elhammady MS, Peterson EC. Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy. J Neurosurg. 127:1361–1373. 2017.
Article
20. Song J, Oh S, Kim MJ, Chung J, Lim YC, Kim BS, et al. Endovascular treatment of ruptured blood blister-like aneurysms with multiple (≥3) overlapping Enterprise stents and coiling. Acta Neurochir (Wien). 158:803–809. 2016.
Article
21. Yu B, Zheng J, Hong Y, Chen L, Xi Z, Yu M, et al. Stent-assisted coil embolization of ruptured supraclinoid blood blister-like aneurysm of internal carotid artery. Turk Neurosurg. 26:219–222. 2016.
22. Zhu D, Fang Y, Yang P, Zhang P, Chen L, Xu Y, et al. Overlapped stenting combined with coiling for blood blister-like aneurysms: comparison of low-profile visualized intraluminal support (LVIS) stent and non-LVIS stent. World Neurosurg. 104:729–735. 2017.
Article
Full Text Links
  • JKNS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr