Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery: Clinical article

Byung Hee Lee, Moon Kim Byung, Sun Park Moon, Il Park Sung, Chul Chung Eun, Hyun Suh Sang, Sik Choi Chun, Sam Won Yu, Kyu Yu In

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Object. Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods. Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results. All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions. In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.

Original languageEnglish
Pages (from-to)431-436
Number of pages6
JournalJournal of neurosurgery
Volume110
Issue number3
DOIs
Publication statusPublished - 2009 Mar 1

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Internal Carotid Artery
Blister
Stents
Aneurysm
Therapeutics
Glasgow Outcome Scale

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Lee, Byung Hee ; Byung, Moon Kim ; Moon, Sun Park ; Sung, Il Park ; Eun, Chul Chung ; Sang, Hyun Suh ; Chun, Sik Choi ; Yu, Sam Won ; In, Kyu Yu. / Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery : Clinical article. In: Journal of neurosurgery. 2009 ; Vol. 110, No. 3. pp. 431-436.
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title = "Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery: Clinical article",
abstract = "Object. Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods. Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results. All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions. In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.",
author = "Lee, {Byung Hee} and Byung, {Moon Kim} and Moon, {Sun Park} and Sung, {Il Park} and Eun, {Chul Chung} and Sang, {Hyun Suh} and Chun, {Sik Choi} and Yu, {Sam Won} and In, {Kyu Yu}",
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Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery : Clinical article. / Lee, Byung Hee; Byung, Moon Kim; Moon, Sun Park; Sung, Il Park; Eun, Chul Chung; Sang, Hyun Suh; Chun, Sik Choi; Yu, Sam Won; In, Kyu Yu.

In: Journal of neurosurgery, Vol. 110, No. 3, 01.03.2009, p. 431-436.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery

T2 - Clinical article

AU - Lee, Byung Hee

AU - Byung, Moon Kim

AU - Moon, Sun Park

AU - Sung, Il Park

AU - Eun, Chul Chung

AU - Sang, Hyun Suh

AU - Chun, Sik Choi

AU - Yu, Sam Won

AU - In, Kyu Yu

PY - 2009/3/1

Y1 - 2009/3/1

N2 - Object. Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods. Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results. All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions. In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.

AB - Object. Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods. Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results. All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions. In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.

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