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Ye Z, Lv X. The formation mechanism of acute dissection of blood blister-like aneurysm and its implication of endovascular treatment. Chin Neurosurg J 2021; 7:32. [PMID: 34078466 PMCID: PMC8173849 DOI: 10.1186/s41016-021-00245-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute mural dissection of the anterior wall of the internal carotid artery which may contribute to the development of blood blister-like aneurysms (BBLAs) was postulated, and stenting or flow diversion treatment across the soi-disant aneurysm was reported in this study. METHODS From December 2016 to December 2018, 8 patients presenting with subarachnoid hemorrhage (SAH) due to BBLA were subjected to endovascular treatment with stent-assisted coiling. Clinical outcomes were evaluated using a clinical outcome score scale. RESULTS Based on angiograms, pathologic change involving the supraclinoid segments of the internal carotid artery (ICA) adjacent to BBLA was found in all patients. This pathologic change meant a focal dissection of the supraclinoid segment of the ICA which constituted the pathogenesis of BBLAs. Closed-cell, open-cell, and braided stents were used in 1, 1, and 6 patients, respectively. Complete obliteration was achieved following endovascular treatment among all 8 patients harboring BBLA. One re-bleeding successive to a closed-cell stent across the aneurysmal neck was observed. Follow-up angiograms revealed stable complete exclusion of all BBLAs from the parent vessel at 3 to 8 months. All patients had a favorable clinical outcome score of 0-1. CONCLUSIONS Acute dissection of a focal point of the intracranial vessels underlies the development of BBLAs. Open-cell and braided-cell stent-assisted coiling may constitute appropriate treatment due to good apposition against the vascular walls. Adjunctive coils may facilitate immediate complete occlusion of BBLAs.
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Affiliation(s)
- Zhongyin Ye
- School of Medicine& School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Litang Road 168, Beijing, 102218, China.
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2
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Chen S, Chen X, Ning B, Cao Y, Wang S. Supraclinoid internal carotid artery blister-like aneurysms: hypothesized pathogenesis and microsurgical clipping outcomes. Chin Neurosurg J 2021; 7:10. [PMID: 33517915 PMCID: PMC7849078 DOI: 10.1186/s41016-020-00226-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Shanwen Chen
- Department of Neurosurgery, the Hospital of Shunyi District, No.3 Guangming Nan Street, Shunyi District, Beijing, 101300, China
| | - Xin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100050, China
| | - Bo Ning
- Department of Neurosurgery, Guangzhou Red Cross Hospital, Jinan University, No. 396 Tongfu Zhong Road, Haizhu District, Guangzhou, 510220, Guangdong, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100050, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100050, China.
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3
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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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4
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Comparison of radiological and clinical characteristics between blood blister-like aneurysms (BBAs) and non-blister aneurysms at the supraclinoid segment of internal carotid artery. Neurosurg Rev 2018; 42:549-557. [DOI: 10.1007/s10143-018-1002-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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5
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Ji T, Guo Y, Huang X, Xu B, Xu K, Yu J. Current status of the treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery: A review. Int J Med Sci 2017; 14:390-402. [PMID: 28553172 PMCID: PMC5436482 DOI: 10.7150/ijms.17979] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/26/2017] [Indexed: 11/05/2022] Open
Abstract
Currently, the treatment of blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA) is challenging and utilizes many therapeutic methods, including direct clipping and suturing, clipping after wrapping, clipping after suturing, coil embolization, stent-assisted coil embolization, multiple overlapping stents, flow-diverting stents, covered stents, and trapping with or without bypass. In these therapeutic approaches, the optimal treatment method for BBAs has not yet been defined based on the current understanding of BBAs of the supraclinoid ICA. Therefore, in this study, we aimed to review the literature from PubMed to discuss and analyze the pros and cons of the above approaches while adding our own viewpoints to the discussion. Among the surgical methods, direct clipping was the easiest method if the compensation of the collateral circulation of the intracranial distal ICA was sufficient or direct clipping did not induce stenosis in the parent artery. In addition, the clipping after wrapping technique should be chosen as the optimal surgical modality to prevent rebleeding from these lesions. Among the endovascular methods, multiple overlapping stents (≥3) with coils may be a feasible alternative for the treatment of ruptured BBAs. In addition, flow-diverting stents appear to have a higher rate of complete occlusion and a lower rate of retreatment and are a promising treatment method. Finally, when all treatments failed or the compensation of the collateral circulation of the intracranial distal ICA was insufficient, the extracranial-intracranial (EC-IC) arterial bypass associated with surgical or endovascular trapping, a complex and highly dangerous method, was used as the treatment of last resort.
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Affiliation(s)
- Tiefeng Ji
- Department of Radiology, The First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Xiuying Huang
- Department of Operation, The First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, P.R. China
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6
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Kubo Y, Koji T, Yoshida K, Saito H, Ogawa A, Ogasawara K. High-flow bypass and wrap-clipping for ruptured blood blister-like aneurysm of the internal carotid artery using intraoperative monitoring of cerebral hemodynamics. Vasc Health Risk Manag 2015; 11:297-302. [PMID: 26082641 PMCID: PMC4461015 DOI: 10.2147/vhrm.s73779] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aneurysms at non-branching sites in the supraclinoid internal carotid artery (ICA) can be classified as “blood blister-like aneurysms” (BBAs), which have blood blister-like configurations and fragile walls. While surgical treatment for the BBA in the acute stage is recommended, the optimal surgical procedure remains controversial. In the study reported here, we describe the case of a 37-year-old woman with a ruptured BBA in the ophthalmic segment of the right ICA who underwent wrap-clipping with external carotid artery–internal carotid artery bypass by intraoperative estimation of the measurement of cortical cerebral blood flow (CoBF) using a thermal diffusion flow probe. Trapping of the ICA in the acute stage of subarachnoid hemorrhage may result in ischemic complications secondary to hemodynamic hypoperfusion or occlusion of the perforating artery, and/or delayed vasospasm, even with concomitant bypass surgery. We believe that it is important to perform scheduled external carotid artery–internal carotid artery bypass before trapping of the ICA in patients with a ruptured BBA in the acute stage of subarachnoid hemorrhage and to perform wrap-clipping rather than trapping. This would provide much more CoBF if a reduction of CoBF occurs after trapping occlusion of the ICA including a ruptured BBA according to intraoperative CoBF monitoring. As far as we are aware, the case reported here is the first report on high-flow bypass and wrap-clipping for a ruptured BBA of the ICA using intraoperative monitoring of cerebral hemodynamics.
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Affiliation(s)
- Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Takahiro Koji
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Hideo Saito
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Akira Ogawa
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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7
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Cho JI, Cho JH. Use of the sundt clip graft in a previously coiled internal carotid artery blister-like aneurysm. J Korean Neurosurg Soc 2014; 56:496-9. [PMID: 25628810 PMCID: PMC4303726 DOI: 10.3340/jkns.2014.56.6.496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/04/2014] [Accepted: 08/06/2014] [Indexed: 11/27/2022] Open
Abstract
Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).
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Affiliation(s)
- Jae Ik Cho
- Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea
| | - Jae Hoon Cho
- Department of Neurosurgery, Daegu Catholic University Hospital, Daegu, Korea
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8
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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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9
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Choi JH, Kim TH, Park SK, Hwang YS, Shin HS, Shin JJ. Combination treatment for rapid growth of a saccular aneurysm on the internal carotid artery dorsal wall: case report. J Cerebrovasc Endovasc Neurosurg 2014; 16:303-8. [PMID: 25340036 PMCID: PMC4205260 DOI: 10.7461/jcen.2014.16.3.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/08/2014] [Accepted: 09/19/2014] [Indexed: 12/02/2022] Open
Abstract
Aneurysms arising from non-branching sites of the supraclinoid internal carotid artery (ICA) are considered rare, accounting for only 0.9-6.5% of all ICA aneurysms. They are thin-walled, broad-based, can easily rupture during surgery, and are referred to as dorsal, superior, anterior, or ventral wall ICA aneurysms, as well as blister-like aneurysms. Various treatment modalities are available for blister-like aneurysms, but with varying success. Here, we report on two cases of saccular shaped dorsal wall aneurysms. Both patients were transferred to the emergency department with subarachnoid hemorrhage because of an aneurysmal rupture. Computed tomography angiography and transfemoral cerebral angiography (TFCA) showed a dorsal wall aneurysm in the distal ICA. We performed clipping on the wrapping material (Lyodura®, temporal fascia). Follow-up TFCA showed rapid configuration changes of the right distal ICA. Coil embolization was also performed as a booster treatment to prevent aneurysm regrowth. Both patients were discharged without neurologic deficit. No evidence of aneurysm regrowth was observed on follow-up TFCA at two years. Dorsal wall ICA aneurysms can change in size over a short period; therefore, follow-up angiography should be performed within the short-term. In cases of regrowth, coil embolization should be considered as a booster treatment.
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Affiliation(s)
- Jae Hyuk Choi
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Hong Kim
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sang Keun Park
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yong Soon Hwang
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyung Shik Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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10
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Kim JK, Kim JH, Kim DR, Kang HI. The sundt encircling clip as a vascular rescue: a case report and a review of repair methods for arterial tearing. J Korean Neurosurg Soc 2014; 55:353-6. [PMID: 25237432 PMCID: PMC4166332 DOI: 10.3340/jkns.2014.55.6.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/02/2014] [Accepted: 06/11/2014] [Indexed: 11/27/2022] Open
Abstract
The Sundt encircling clip was developed to repair defects of the vessel wall. With the advent of microvascular techniques, most parts of the damaged vessel wall during aneurysm surgery can be repaired by primary closure or by the bypass technique. However, these methods are not always successful. Here, we illustrate two cases of surgical clipping with the Sundt encircling clip in the ruptured internal carotid artery trunk aneurysm. The Sundt clip provides prompt control of unexpected tearing of the vessel wall or aneurysm and plays an important role in vascular rescue during aneurysm surgery.
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Affiliation(s)
- Jin Kwon Kim
- Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea
| | - Duk Ryung Kim
- Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea
| | - Hee In Kang
- Department of Neurosurgery, Eulji University Eulji Hospital, Seoul, Korea
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11
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Cho TG, Hwang SN, Nam TK, Park SW. Salvage surgical treatment for failed endovascular procedure of a blood blister-like aneurysm. J Cerebrovasc Endovasc Neurosurg 2012; 14:99-103. [PMID: 23210036 PMCID: PMC3471259 DOI: 10.7461/jcen.2012.14.2.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 02/28/2012] [Accepted: 04/18/2012] [Indexed: 11/23/2022] Open
Abstract
The blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is a rare but clinically important cause of subarachnoid hemorrhage (SAH), which accounts for 0.5% of incidences of ruptured intracranial aneurysms. BBA is a thin-walled, broad-based aneurysm that lacks an identifiable neck and is one of the most difficult lesions to treat. In this paper, a case is presented of a 57-year-old woman with SAH. Her cerebral angiography demonstrated a small BBA on the dorsal wall of her right ICA. Endovascular treatment that consisted of a stent-within-a-stent was attempted, but the replacement of the second stent failed, and the aneurysm became bigger. Surgery was performed by clipping the BBA with a Sundt slim-line encircling graft clip. The patient completely recovered with no complications. This treatment may be a salvageable option for BBA, especially when endovascular treatment has failed.
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Affiliation(s)
- Tack Geun Cho
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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12
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ISHIKAWA T, MUTOH T, NAKAYAMA N, YASUDA H, NOMURA M, KAZUMATA K, MOROI J, YASUI N. Universal External Carotid Artery to Proximal Middle Cerebral Artery Bypass With Interposed Radial Artery Graft Prior to Approaching Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery -Technical Note-. Neurol Med Chir (Tokyo) 2009; 49:553-8. [DOI: 10.2176/nmc.49.553] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tatsuya ISHIKAWA
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita
| | - Tatsushi MUTOH
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita
| | - Naoki NAKAYAMA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | | | - Mikio NOMURA
- Department of Neurosurgery, Keiwa-kai Ebetsu Hospital
| | - Ken KAZUMATA
- Department of Neurosurgery, Teine Keijinkai Hospital
| | - Junta MOROI
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita
| | - Nobuyuki YASUI
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita
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Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature. CHANGING ASPECTS IN STROKE SURGERY: ANEURYSMS, DISSECTIONS, MOYAMOYA ANGIOPATHY AND EC-IC BYPASS 2008; 103:51-5. [DOI: 10.1007/978-3-211-76589-0_10] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Krayenbühl N, Khan N, Cesnulis E, Imhof HG, Yonekawa Y. Emergency extra-intracranial bypass surgery in the treatment of cerebral aneurysms. CHANGING ASPECTS IN STROKE SURGERY: ANEURYSMS, DISSECTIONS, MOYAMOYA ANGIOPATHY AND EC-IC BYPASS 2008; 103:93-101. [DOI: 10.1007/978-3-211-76589-0_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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FUJIOKA S, NISHI T, KOGA K, GOTO T, HAMADA K, TSUIKI H, KAJI M, SUMI K. Ruptured Blister-like Aneurysm Originating from the Anterior Wall of the Internal Carotid Artery: Counterplans for Pitfalls in Diagnosis and Treatment. ACTA ACUST UNITED AC 2008. [DOI: 10.2335/scs.36.38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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HONGO K, SATO A, KAKIZAWA Y, MIYAHARA T, TANAKA Y, SUGIYAMA T. The Nationwide Surveillance on the Dorsal Aneurysm of the Internal Carotid Artery Part 1: Analysis of the Factors Affecting the Poor Outcome. ACTA ACUST UNITED AC 2006. [DOI: 10.2335/scs.34.366] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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