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Huang B, Ren Y, Liu H, Xiao A, Liu L, Sun H, Liu Y, Li H, Ma L, Zhang CW, Wang CH, He M, Zhang Y, You C, Li J. Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study. J Korean Neurosurg Soc 2024; 67:345-353. [PMID: 37850224 PMCID: PMC11079558 DOI: 10.3340/jkns.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/07/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. METHODS The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. RESULTS A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin scale, 0-2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. CONCLUSION In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.
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Affiliation(s)
- Bowen Huang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Neurosurgery, Shangjin nanfu hospital, Sichuan University, Chengdu, China
| | - Anqi Xiao
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Lunxin Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Sun
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chang-Wei Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chao-Hua Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Min He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Neurosurgery, Shangjin nanfu hospital, Sichuan University, Chengdu, China
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Matsumoto Y, Nakae R, Matano F, Kubota A, Morita A, Murai Y, Yokobori S. A Case of Ruptured Carotid Traumatic Blood Blister-like Aneurysm. NMC Case Rep J 2023; 10:259-263. [PMID: 37869375 PMCID: PMC10584784 DOI: 10.2176/jns-nmc.2023-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/28/2023] [Indexed: 10/24/2023] Open
Abstract
Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.
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Affiliation(s)
- Yoshiyuki Matsumoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Murai Y, Matano F, Shirokane K, Tateyama K, Koketsu K, Nakae R, Sekine T, Mizunari T, Morita A. Lesion Trapping with High-Flow Bypass for Ruptured Internal Carotid Artery Blood Blister-Like Aneurysm Has Little Impact on the Anterior Choroidal Artery Flow: Case Series and Literature Review. World Neurosurg 2021; 153:e226-e236. [PMID: 34175486 DOI: 10.1016/j.wneu.2021.06.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the relationship between trap location and cerebral infarction in the anterior choroidal artery (AChA) region and associated risks in ruptured internal carotid artery blood blister-like aneurysm (BLA) treatment with high-flow bypass and lesion trapping. METHODS We included 26 patients diagnosed with BLAs and treated with high-flow bypass and trapping. We examined clinical characteristics including age, aneurysm trap location, final prognosis, cerebral infarction on postoperative magnetic resonance imaging, and modified Rankin Scale score at discharge. We also searched the literature for similar studies. RESULTS The modified Rankin Scale score at discharge was 0-2 in 20 patients, 3-5 in 2 patients, and 6 in 2 patients. In 19/26 patients (73.1%), the trapped segment was between the posterior communicating (PcomA) and the ophthalmic arteries. In 2 patients (7.7%), the trapped segment included the PcomA and the AChA; in 4 patients (15.4%), the trapped segment was within the PcomA. In these patients, the PcomA was occluded, and blood from the high-flow bypass flowed out to the AChA alone. No patient showed cerebral infarction. Our systematic review identified 70 patients. Of all 96 patients, 12 had AChA cerebral infarction; however, the infarction affected the prognosis of only 2 patients. CONCLUSIONS When treating BLAs with high-flow bypass and lesion trapping, the frequency of AChA cerebral infarction is low even when the PcomA is occluded, leaving the AChA as the only outflow vessel during high-flow bypass. However, PcomA occlusion may be associated with risks when treating patients with advanced arteriosclerosis near C1-2.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo, Tokyo, Japan.
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo, Tokyo, Japan
| | - Kazutaka Shirokane
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Kojiro Tateyama
- Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo, Tokyo, Japan
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Bunkyo, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashikosugi Hospital, Kanagawa, Japan
| | - Takayuki Mizunari
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo, Tokyo, Japan
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Balik V, Takebayashi S, Takizawa K. A Case Series of Double Bypass Technique Used for the Treatment of Internal Carotid Blood Blister-like Aneurysms in Patients in Poor Initial Neurological Condition at the Early Stage of Subarachnoid Hemorrhage. Oper Neurosurg (Hagerstown) 2021; 18:126-135. [PMID: 31232429 DOI: 10.1093/ons/opz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optimal surgical treatment of blood-blister aneurysms (BBA) remains controversial. Some surgeons prefer clipping reconstruction while others favor primary bypass with trapping. OBJECTIVE To analyze of benefit of double bypass technique to surgical outcomes in patients with ruptured BBA in poor initial neurological condition (PINC). METHODS Retrospective analysis of clinical, radiological, and surgical data in 9 patients treated between January 2009 and December 2015. Intraoperative middle cerebral artery blood pressure (MCABP) measurement was used for selection of bypass procedure. RESULTS Seven patients presented with World Federation of Neurosurgical Societies (WFNS) subarachnoid hemorrhage (SAH) score 4 or 5. No pulse pressure in the MCA after internal carotid artery (ICA) clamping was found in 3 patients, although their ACoA or PCoA were well visualized on preoperative angiograms. By contrast, only a minimal drop in MCABP following ICA clamping was detected in two cases, although their collaterals were slim/nonvisualized on imaging. Although angiographic vasospasms were not observed in our patients, two of them experienced cerebral infarction, attributable more to the mass effect and postoperative ICA thrombosis than to SAH-induced vasospasm. There were 2 premature intraoperative ruptures, but no perioperative mortality, aneurysm recurrence, or rebleeding. Five patients with WFNS SAH score 4 or 5 achieved favorable outcomes. CONCLUSION Early double bypass technique guided by MCABP measurement and combined with trapping (or rarely clipping) seems to be a safe method with excellent long-term outcomes in patients in PINC. This study may thus contribute to the debate on the optimal treatment strategy for BBA.
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Affiliation(s)
- Vladimir Balik
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University and Faculty Hospital Olomouc, Olomouc, Czech Republic.,Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
| | - Seiji Takebayashi
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Hokkaido, Japan
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Comparison of Bypass and Non-Bypass Surgical Treatments for Internal Carotid Artery Blood Blister-Like Aneurysms: A Meta-Analysis of Efficacy, Safety, and Outcomes. World Neurosurg 2020; 144:283-292.e12. [PMID: 32829023 DOI: 10.1016/j.wneu.2020.08.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The optimal surgical strategy for treating internal carotid artery (ICA) blood blister-like aneurysms (BBAs) has remained unclear. Although some have preferred bypass surgery, others have favored less-demanding surgical methods. The aim of the present meta-analysis was to assess the efficacy, safety, and outcomes of bypass and non-bypass surgical methods when intended as primary treatment of ICA BBAs. METHODS Studies reporting data on the outcomes of interest for surgically treated patients with ICA BBAs were searched for in the PubMed/MEDLINE, Evidence-Based Medicine Reviews, Cochrane Central, ProQuest, and Scopus databases. The data were analyzed using random effects modeling. RESULTS Seven observational studies involving 140 patients met the inclusion criteria. The patients treated with bypass surgery, compared with those treated with non-bypass techniques, had lower odds of poor outcomes (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.28-2.02; P = 0.57; I2 = 0%), postoperative vasospasm (OR, 1.73; 95% CI, 0.38-7.92; P = 0.48; I2 = 19%), intraoperative bleeding (OR, 3.37; 95% CI, 0.82-13.90; P = 0.09; I2 = 0%), postoperative bleeding (OR, 1.91; 95% CI, 0.47-7.76; P = 0.36; I2 = 0%), and postoperative recurrence of BBAs (OR, 2.16; 95% CI, 0.54-8.66; P < 0.28; I2 = 0%). No comparison, however, achieved statistical significance. CONCLUSIONS For surgeons who use both bypass and non-bypass surgical strategies, the 2 methods seemed comparable in terms of the outcomes of interest, although the bypass technique appeared superior. However, comparisons with studies reporting bypass as the uniquely preferred technique have indicated that specialization in, and preference for, the bypass procedure has been associated with more favorable outcomes.
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Meling TR, Patet G. The role of EC-IC bypass in ICA blood blister aneurysms-a systematic review. Neurosurg Rev 2020; 44:905-914. [PMID: 32318921 PMCID: PMC8035099 DOI: 10.1007/s10143-020-01302-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
To perform a systematic review of extracranial-to-intracranial (EC-IC) bypass surgery with parent vessel trapping for blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) according to PRISMA guidelines. Search of PubMed using “bypass” [all fields] and “ICA” [all fields] or “internal carotid artery” [all fields] and (“blood blister–like aneurysm” [MeSH terms]. Thirty-four original articles were identified, of which 21 were excluded (treatment not including bypass or insufficient details on complications or clinical outcomes). Thirteen articles published between 2008 and 2019 were included, totaling 98 patients, with a median of 7.5 patients per article (range 1–17). Mean age was 53.3 years (range 23–80). The main techniques were external carotid artery to middle cerebral artery (ECA-MCA) in 81% and superficial temporal artery to MCA (STA-MCA) in 19%. The most common grafts were radial artery (74%) and STA (19%). The risk of intraoperative rupture varied from 0 to 75%, with a mean of 12%. With respect to clinical outcomes, the modified Rankin Scale (mRS) was not stated in 30% of the cases. When stated, mRS was ≤ 2 in 79%, mRS was 3–5 in 10%, and 4% had mRS 6 (death). We identified only 13 articles, with no prospective studies. Outcomes were better than generally reported for ruptured aneurysms, both with respect to poor outcome (mRS > 2) and in-hospital mortality, perhaps reflecting a selection bias. In general, the data reporting quality was low, precluding any firm conclusions, but EC-IC bypass with ICA trapping may be a valid treatment option for ruptured ICA BBAs.
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Affiliation(s)
- Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Service de Neurochirurgie, Hôpitaux Universitaires de Genève, Rue Gabriel-Perret-Gentil 5, 1205, Genève, Switzerland. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Gildas Patet
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
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Lee HS, Ahn JS, Park JC, Lee S, Kim M, Park W. Dominance of the Anterior Cerebral Artery as a Predictor of Vasospasm-Related Cerebral Infarction After Surgical Treatment of Ruptured Blood Blister-Like Aneurysm in the Internal Carotid Artery. World Neurosurg 2019; 130:e513-e524. [DOI: 10.1016/j.wneu.2019.06.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
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Kim YS, Joo SP, Kim TS. Microsurgical Management of Ruptured Blood Blister Aneurysms of the Internal Carotid Artery without Bypass: A Retrospective Single-Center Study of 36 Patients over 20 Years. World Neurosurg 2019; 128:e956-e965. [DOI: 10.1016/j.wneu.2019.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
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Hanihara M, Yoshioka H, Kanemaru K, Hashimoto K, Shimizu M, Nishigaya K, Fukamachi A, Kinouchi H. Long-Term Clinical and Angiographic Outcomes of Wrap-Clipping for Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery Using Advanced Monitoring. World Neurosurg 2019; 126:e439-e446. [DOI: 10.1016/j.wneu.2019.02.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
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Sorimachi T. In Reply to “Direct Suturing Technique for Ruptured Blood-Blister Aneurysm: The Forgotten Way”. World Neurosurg 2019; 123:473. [DOI: 10.1016/j.wneu.2018.12.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
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Sorimachi T, Osada T, Hirayama A, Shigematsu H, Srivatanakul K, Matsumae M. Preservation of Anterior Choroidal Artery Blood Flow During Trapping of the Internal Carotid Artery for a Ruptured Blood Blister-Like Aneurysm with High-Flow Bypass. World Neurosurg 2019; 122:e847-e855. [DOI: 10.1016/j.wneu.2018.10.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
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Clipping on Crossed Wrapping Method for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: Technical Note and Long-Term Results. World Neurosurg X 2019; 2:100005. [PMID: 31218280 PMCID: PMC6580898 DOI: 10.1016/j.wnsx.2018.100005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background We have been performing the clipping on crossed wrapping (COCW) method using 2 strips of cotton on patients with an internal carotid artery blood blister-like aneurysm (IC-BLA). This method is reliable in preventing the clips from slipping off and the aneurysm walls from being damaged during clipping, and it enables more appropriate and safer clipping. Here we report the technical details of this method and the long-term outcomes of patients receiving this procedure. Methods Fifteen of 1275 (1.5%) patients with a ruptured cerebral aneurysm who received treatment at the Saiseikai Kumamoto Hospital during the period from January 1, 1999, to December 31, 2016, had an IC-BLA. All 15 patients were treated with COCW, except for the first patient, who was treated using a single strip of cotton. The long-term outcome of the treatment was analyzed. Results The mean follow-up period was 74 months. The first patient experienced rerupture of an aneurysm 10 days after the operation. No complications or regrowth of an aneurysm were observed in the remaining 14 patients during the follow-up period, except for 1 patient who received a reoperation for the regrowth of an aneurysm. As the final outcome, the numbers of patients with a Modified Rankin Score of 0, 3, and 6 were 13, 1, and 1, respectively. Conclusions It is suggested that COCW is a treatment that enables safe and long-term management of lesions in IC-BLAs.
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Key Words
- 3D-CTA, Three-dimensional computed tomographic angiography
- AchA, Anterior choroidal artery
- BBA, Blood blister-like aneurysm
- Blood blister-like aneurysm
- COCW, Clipping on crossed wrapping
- COW, Clipping on wrapping
- CT, Computed tomography
- Clipping on crossed wrapping
- Clipping on wrapping
- Direct surgery
- IC, Internal carotid
- IC-BBAs, BBAs of the ICA
- ICA, Internal carotid artery
- Internal carotid artery aneurysm
- PcomA, Posterior communicating artery
- SAH, Subarachnoid hemorrhage
- mRS, Modified Rankin Scale
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Orita E, Murai Y, Sekine T, Takagi R, Amano Y, Ando T, Iwata K, Obara M, Kumita S. Four-Dimensional Flow MRI Analysis of Cerebral Blood Flow Before and After High-Flow Extracranial–Intracranial Bypass Surgery With Internal Carotid Artery Ligation. Neurosurgery 2018; 85:58-64. [DOI: 10.1093/neuros/nyy192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erika Orita
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Yasuo Murai
- Depar-tment of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Ryo Takagi
- Department of Radiology, Nippon Medical School, Tokyo, Japan
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Amano
- Department of Radiology, Nippon Medical School, Tokyo, Japan
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Kotomi Iwata
- Department of Radiology, Nippon Medical School, Tokyo, Japan
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Current trends in the surgical management of blister aneurysms. An illustrative case series. Clin Neurol Neurosurg 2018. [DOI: 10.1016/j.clineuro.2018.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Outcome After Subarachnoid Hemorrhage from Blood Blister–Like Aneurysm Rupture Depends on Age and Aneurysm Morphology. World Neurosurg 2017; 105:944-951.e1. [DOI: 10.1016/j.wneu.2017.06.129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/20/2022]
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Results of Early High-Flow Bypass and Trapping for Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery. World Neurosurg 2017; 105:470-477. [DOI: 10.1016/j.wneu.2017.06.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/18/2022]
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17
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Matano F, Murai Y, Mizunari T, Tamaki T, Tateyama K, Koketsu K, Tanikawa R, Kamiyama H, Kobayashi S, Morita A. Recovery of Visual and Ophthalmologic Symptoms After Treating Large or Giant Internal Carotid Artery Aneurysm by High-Flow Bypass with Cervical Ligation. World Neurosurg 2017; 98:182-188. [DOI: 10.1016/j.wneu.2016.10.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022]
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Owen CM, Montemurro N, Lawton MT. Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy. Neurosurgery 2017; 80:235-247. [DOI: 10.1227/neu.0000000000001259] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established.
OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically.
METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping.
RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2).
CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.
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Affiliation(s)
- Christopher M. Owen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Nicola Montemurro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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19
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Han Z, Qi H, Yin W, Du Y. Letter to the Editor: Low-flow bypass and wrap-clipping for ruptured blister aneurysms of the ICA. J Neurosurg 2016; 124:1143-4. [PMID: 26894461 DOI: 10.3171/2015.10.jns152277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zongli Han
- Peking University Shenzhen Hospital, Futian District, Shenzhen, Guangdong, P. R. China; and ,School of Medical Technology and Nursing, Shenzhen Polytechnic, Xili Lake, Nanshan District, Shenzhen, Guangdong, P. R. China
| | - Hui Qi
- Peking University Shenzhen Hospital, Futian District, Shenzhen, Guangdong, P. R. China; and ,School of Medical Technology and Nursing, Shenzhen Polytechnic, Xili Lake, Nanshan District, Shenzhen, Guangdong, P. R. China
| | - Wei Yin
- Peking University Shenzhen Hospital, Futian District, Shenzhen, Guangdong, P. R. China; and ,School of Medical Technology and Nursing, Shenzhen Polytechnic, Xili Lake, Nanshan District, Shenzhen, Guangdong, P. R. China
| | - Yanli Du
- Peking University Shenzhen Hospital, Futian District, Shenzhen, Guangdong, P. R. China; and ,School of Medical Technology and Nursing, Shenzhen Polytechnic, Xili Lake, Nanshan District, Shenzhen, Guangdong, P. R. China
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20
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Endo H, Fujimura M, Shimizu H, Inoue T, Sato K, Niizuma K, Tominaga T. Cerebral Blood Flow after Acute Bypass with Parent Artery Trapping in Patients with Ruptured Supraclinoid Internal Carotid Artery Aneurysms. J Stroke Cerebrovasc Dis 2015. [PMID: 26194848 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Bypass with parent artery trapping is an alternative treatment method for ruptured internal carotid artery (ICA) aneurysms when clipping or coiling is contraindicated. However, the efficacy and safety of this strategy during the acute stage of subarachnoid hemorrhage (SAH) is undetermined. METHODS A retrospective review of 955 consecutive patients presenting SAH between 2006 and 2014 identified 17 patients with ruptured ICA aneurysms treated by bypass with parent artery trapping within 72 hours after the bleeding (bypass group). The 26 cases with ruptured posterior communicating artery aneurysms treated with clipping during the same period were defined as a control group (clipping group). Postoperative cerebral blood flow (CBF) was evaluated by single photon emission computed tomography (SPECT). We analyzed the postoperative hemodynamic status, surgical complications, and the clinical outcomes. RESULTS Postoperative rebleeding did not occur in any of the cases. CBF in the first postoperative week in the bypass group was lower than that in the clipping group (P = .0165). This CBF decrease improved in the second postoperative week and did not differ from that of the clipping group. The incidence of acute ischemic complications was significantly higher in the bypass group (P = .0284), but the incidence of delayed cerebral ischemia did not differ between the 2 groups. The incidence of favorable outcomes at 6 months was 82.4% in the bypass group and 81% in the clipping group. CONCLUSIONS Although the transient CBF decrease with acute ischemic complications should be noted, acute bypass with parent artery trapping is safe and effective for unclippable/uncoilable ruptured ICA aneurysms.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
| | - Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Inoue
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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21
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Mooney MA, Kalani MYS, Nakaji P, Albuquerque FC, McDougall CG, Spetzler RF, Zabramski JM. Long-term Patient Outcomes After Microsurgical Treatment of Blister-Like Aneurysms of the Basilar Artery. Oper Neurosurg (Hagerstown) 2015; 11 Suppl 3:387-93. [DOI: 10.1227/neu.0000000000000866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Blister-like aneurysms (BLAs) are challenging lesions that require unique microsurgical strategies. BLAs are predominantly found along the internal carotid artery; however, BLAs of the basilar artery are a rare subset that requires a modified treatment strategy.
OBJECTIVE
To discuss the microsurgical management and review the long-term outcomes of patients with BLAs of the basilar artery.
METHODS
We retrospectively reviewed the surgical technique, postoperative results, and long-term outcomes of all patients with basilar artery BLAs treated at our institution from 2005 to 2011.
RESULTS
Four patients with basilar artery BLAs were identified over this 6-year interval. All 4 patients were treated by direct microsurgical clipping. A thin layer of cotton reinforcement was used beneath the clip tines to minimize the risk of clip slippage in 2 of 4 patients; 1 patient required adjunctive endovascular stent placement for residual aneurysm after clipping. Complete obliteration of all aneurysms was achieved, and there has been no recurrence at mean clinical follow-up of 72 months (median, 74.5; range, 37-103) and imaging follow-up of 48 months (median, 54; range 12-72).
CONCLUSION
Direct clipping with or without cotton reinforcement can obliterate basilar BLAs with excellent long-term outcomes. Clip wrapping is not an option for these lesions given the proximity to perforating branches. Endovascular techniques provide a useful adjunctive strategy; however, risks with antiplatelet therapy in the acute subarachnoid hemorrhage period must be considered.
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Affiliation(s)
- Michael A Mooney
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M Yashar S Kalani
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Felipe C Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cameron G McDougall
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Joseph M Zabramski
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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22
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Bojanowski MW, Weil AG, McLaughlin N, Chaalala C, Magro E, Fournier JY. Morphological aspects of blister aneurysms and nuances for surgical treatment. J Neurosurg 2015; 123:1156-65. [PMID: 26053352 DOI: 10.3171/2014.11.jns141004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Blister aneurysms of the supraclinoid part of the internal carotid artery (ICA) are known for their high morbidity and mortality rates related to treatment, regardless of whether the treatment is surgical or endovascular. However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions. The goal of this study was 2-fold: to determine whether different blister aneurysm morphologies present different pitfalls, which would then require different surgical strategies, as well as to determine whether there are identifiable subgroups of these types of aneurysms based on morphology. METHODS The authors reviewed the charts, cerebral catheter angiograms, surgical reports, and intraoperative videos of all ICA blister aneurysms treated surgically at the Centre Hospitalier de l'Université de Montréal from 2005 to 2012 to investigate whether there was a relationship between morphology and pitfalls, and whether different surgical strategies had been used according to these pitfalls. During this review process the authors noted 4 distinct morphological aspects. These 4 aspects led to a review of the English and French literature on blister aneurysms in which imaging was available, to determine whether other cases could also be classified into the same 4 subgroups based on these morphological aspects. RESULTS The retrospective review of the authors' series of 10 patients allowed a division into 4 distinct subtypes: Type I (classic), Type II (berry-like), Type III (longitudinal), and Type IV (circumferential). These subtypes may at times be progressive stages in the arterial anomaly, and could represent a continuum. Each subtype described in this paper presented its own pitfalls and required specific surgical adaptations. Upon reviewing the literature the authors retained 35 studies involving a total of 61 cases of blister aneurysms, and all cases were able to be classified into 1 of these 4 distinct subtypes. CONCLUSIONS Although they share some common characteristics, blister aneurysms may be divided into distinct subtypes, suggestive of a continuum. Such a classification with a detailed description of each type of blister aneurysm would allow for better recognition to anticipate complications during intervention and better assess the different treatment strategies according to the subtypes.
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Affiliation(s)
- Michel W Bojanowski
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada; and
| | - Alexander G Weil
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada; and
| | - Nancy McLaughlin
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada; and
| | - Chiraz Chaalala
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada; and
| | - Elsa Magro
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada; and
| | - Jean-Yves Fournier
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada; and.,Department of Neurosurgery, Cantonal Hospital of St. Gallen, Switzerland
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23
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Nakagawa S, Murai Y, Wada T, Tateyama K. 4D flow preliminary investigation of a direct carotid cavernous fistula due to a ruptured intracavernous aneurysm. BMJ Case Rep 2015; 2015:bcr-2014-206084. [PMID: 25612750 DOI: 10.1136/bcr-2014-206084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inadequate information is available about the cerebral blood flow and surgical strategies of a direct aneurysmal carotid cavernous fistula (daCCF). We report a quantitative analysis of flow velocity and volume using preoperative time-resolved phase-contrast MRI (four-dimensional (4D) flow MRI) in a daCCF. This is the first report of 4D flow findings with a daCCF. A 55-year-old woman developed a sudden headache and bruit of the right orbit, and MRI suggested the presence of a daCCF. Quantitative analysis using preoperative 4D flow MRI revealed the flow volume of the right internal carotid artery. The daCCF was successfully treated by high-flow bypass using a radial artery graft and internal carotid artery trapping. Postoperative angiography showed a complete obliteration of the daCCF. Studies to collect data from additional cases are required so that 4D flow findings can be further used in the management of daCCFs.
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Affiliation(s)
| | - Yasuo Murai
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Takeshi Wada
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Kojiro Tateyama
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
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Park J. Blood blister-like aneurysm with rupture point close to origin of anterior choroidal artery. J Korean Neurosurg Soc 2014; 56:500-3. [PMID: 25628811 PMCID: PMC4303727 DOI: 10.3340/jkns.2014.56.6.500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/11/2014] [Accepted: 08/31/2014] [Indexed: 12/12/2022] Open
Abstract
If a ruptured blood blister-like aneurysm (BBA) arises from the lateral or superolateral wall of the internal carotid artery (ICA) at the level of the anterior choroidal artery (AChA), its proximity to the origin of the AChA presents a serious surgical challenge to preserve the patency of the AChA. Two such rare cases are presented, along with successful surgical techniques, including the application of a C-shaped aneurysm clip parallel to the ICA and a microsuture technique to repair the arterial defect. The patency of the AChA and ICA was successfully preserved without recurrence or rebleeding of the BBA during a 1-year follow-up after the operation.
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Affiliation(s)
- Jaechan Park
- Department of Neurosurgery, Research Center for Neurosurgical Robotic System, Kyungpook National University, Daegu, Korea
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25
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Target-controlled infusion technique with indocyanine green videoangiography for radial artery graft. Clin Neurol Neurosurg 2014; 119:70-4. [DOI: 10.1016/j.clineuro.2014.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/27/2013] [Accepted: 01/19/2014] [Indexed: 11/17/2022]
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Indo M, Oya S, Tanaka M, Matsui T. High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation. J Neurosurg 2013; 120:93-8. [PMID: 24180574 DOI: 10.3171/2013.9.jns131030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgery for aneurysms at the anterior wall of the internal carotid artery (ICA), which are also referred to as ICA anterior wall aneurysms, is often challenging. A treatment strategy needs to be determined according to the pathology of the aneurysm-namely, whether the aneurysm is a saccular aneurysm with firm neck walls that would tolerate clipping or coiling, a dissecting aneurysm, or a blood blister-like aneurysm. However, it is not always possible to properly evaluate the condition of the aneurysm before surgery solely based on angiographic findings. METHODS The authors focused on the location of the ophthalmic artery (OA) in determining the pathology of ICA anterior wall aneurysms. Between January 2006 and December 2012, diagnostic cerebral angiography, for any reason, was performed on 1643 ICAs in 855 patients at Saitama Medical Center. The authors also investigated the relationship between the origin of the OA and the incidence of ICA anterior wall aneurysms. The pathogenesis was also evaluated for each aneurysm based on findings from both angiography and open surgery to identify any correlation between the location where the OA originated and the conditions of the aneurysm walls. RESULTS Among 1643 ICAs, 31 arteries (1.89%) were accompanied by an anomalous origin of the OA, including 26 OAs originating from the C3 portion, 3 originating from the C4 portion, and 2 originating from the anterior cerebral artery. The incidence of an anomalous origin of the OA had no relationship to age, sex, or side. Internal carotid artery anterior wall aneurysms were observed in 16 (0.97%) of 1643 ICAs. Female patients had a significantly higher risk of having ICA anterior wall aneurysms (p = 0.026). The risk of ICA anterior wall aneurysm formation was approximately 50 times higher in patients with an anomalous origin of the OA (25.8% [8 of 31]) than in those with a normal OA (0.5% [8 of 1612], p < 0.0001). Based on angiographic classifications, saccular aneurysms were significantly more common in patients with an anomalous origin of the OA than in those with a normal OA (p = 0.041). Ten of 16 patients with ICA anterior wall aneurysms underwent craniotomies. Based on the intraoperative findings, all 6 aneurysms with normal OAs were dissecting or blood blister-like aneurysms, not saccular aneurysms. CONCLUSIONS There was a close relationship between the location of the OA origin and the predisposition to ICA anterior wall aneurysms. Developmental failure of the OA and subsequent weakness of the vessel wall might account for this phenomenon, as previously reported regarding other aneurysms related to the anomalous development of parent arteries. The data also appear to indicate that ICA anterior wall aneurysms in patients with an anomalous origin of the OA tend to be saccular aneurysms with normal neck walls. These findings provide critical information in determining therapeutic strategies for ICA anterior wall aneurysms.
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Affiliation(s)
- Masahiro Indo
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama; and
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Kazumata K, Nakayama N, Nakamura T, Kamiyama H, Terasaka S, Houkin K. Changing Treatment Strategy From Clipping to Radial Artery Graft Bypass and Parent Artery Sacrifice in Patients With Ruptured Blister-Like Internal Carotid Artery Aneurysms. Oper Neurosurg (Hagerstown) 2013; 10 Suppl 1:66-72; discussion 73. [DOI: 10.1227/neu.0000000000000076] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Blood blister-like aneurysms (BBAs) are aneurysms with ill-defined fragile necks arising from an internal carotid artery (ICA) and associated with high mortality.
OBJECTIVE:
To describe strategies and outcomes in patients in whom radial artery (RA) graft bypass with ICA sacrifice was considered as the primary treatment during the acute phase of subarachnoid hemorrhage.
METHODS:
The authors analyzed the clinical records of 20 patients who were treated between 2004 and 2011 at their hospital and affiliate institutions.
RESULTS:
A majority of the patients were treated during the acute phase (<24 hours, n = 15). A favorable outcome was achieved in 18 (90%) patients. The treatment strategies used were as follows: (1) ICA trapping/external carotid artery (ECA)-RA-middle cerebral artery (MCA) bypass (n = 13), (2) ICA trapping/superficial temporal artery-MCA bypass (n = 2), (3) aneurysm clipping with RA-MCA temporary bypass (n = 3), (3) aneurysm clipping with proximal ICA ligation and ECA-RA-MCA bypass (n = 1), and (4) direct clipping (n = 1). Postoperative infarction was observed in 6 patients and was ascribed to vasospasm (n = 1), retrograde thrombosis associated with trapping (n = 2), and reasons unrelated to the surgical procedures (n = 3).
CONCLUSION:
Trapping with RA graft bypass demonstrated favorable results in patients with internal carotid BBAs. Although trapping/RA graft bypass is a definitive treatment for BBAs located proximal to the origin of the posterior communicating artery, some distal BBAs preclude ICA trapping to spare the perforating arteries.
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Affiliation(s)
- Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | - Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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MURAI Y, MIZUNARI T, KOBAYASHI S, UMEOKA K, TATEYAMA K, KOKETSU K, MATANO F, KITAMURA T, TERAMOTO A. Basic Techniques of Radial Artery Graft to Prevent Surgical Complications. ACTA ACUST UNITED AC 2013. [DOI: 10.2335/scs.41.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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