Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy

• Published in: Neuroradiology 2013-03, Vol.55 (4), p.441-447
• Main Authors: Çinar, Celal, Oran, İsmail, Bozkaya, Halil, Ozgiray, Erkin
• Format: Article
• Language: English
• Subjects: Adult; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Aneurysms; Blood Vessel Prosthesis; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - surgery; Cerebral Angiography - methods; Endovascular Procedures; Humans; Imaging; Interventional Neuroradiology; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Medical imaging; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Radiology; Retrospective Studies; Rupture, Spontaneous - diagnostic imaging; Rupture, Spontaneous - surgery; Stents; Tomography, X-Ray Computed - methods; Treatment Outcome; Veins & arteries
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-013-1136-y

Introduction The current literature describing surgical and endovascular interventions in blister-like aneurysms (BAs) offers no clear consensus on the optimal treatment modality. The aim of this study was to assess the clinical and angiographic features of ruptured BAs treated endovascularly using predominantly flow-diversion strategy. Methods The initial clinical and radiological findings, endovascular treatment results, clinical outcomes, and follow-up angiographic findings of seven BAs (one man and six women; mean age, 44.5 years; range, 33–50 years) were retrospectively evaluated. Results All seven BAs were located in the supraclinoid internal carotid artery. Two patients were managed initially by other endovascular treatment options, after that flow-diverting strategy became intention to treat in these two and the remaining five patients. Flow-diverting treatment with pipeline stent (Covidien/Ev3) could be accomplished in all but one patient who was treated by parent artery occlusion due to an access problem. Dual antiaggregant loading was performed 6–8 h before treatment in all patients. No re-bleeding or thrombotic complication occurred periprocedurally. Long-term control angiography was available in all patients revealing occluded aneurysm. The clinical outcome (mRS) was good in five and moderate in two patients. Conclusions Endovascular reconstructive treatment of a ruptured BA using a flow-diverting device is a promising strategy that can be performed with acceptable clinical and good radiological results.