Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil

Yong Cheol Lim, Byung Moon Kim, Sang Hyun Suh, Pyoung Jeon, Sang Heum Kim, Yon Kwon Ihn, Young Jun Lee, Sook Young Sim, Joonho Chung, Dong Joon Kim, Dong Ik Kim

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Controversy remains about the optimal treatment for blood blister-like aneurysms (BBAs). Objective: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. Methods: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. Results: Initial treatments were ≥ 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0%) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4%, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7%, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence (P < .05). Conclusion: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment.

Original languageEnglish
Pages (from-to)480-488
Number of pages9
JournalNeurosurgery
Volume73
Issue number3
DOIs
Publication statusPublished - 2013 Sep 1

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Blister
Stents
Aneurysm
Recurrence
Therapeutics
Systemic Lupus Erythematosus
Angiography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Lim, Yong Cheol ; Kim, Byung Moon ; Suh, Sang Hyun ; Jeon, Pyoung ; Kim, Sang Heum ; Ihn, Yon Kwon ; Lee, Young Jun ; Sim, Sook Young ; Chung, Joonho ; Kim, Dong Joon ; Kim, Dong Ik. / Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil. In: Neurosurgery. 2013 ; Vol. 73, No. 3. pp. 480-488.
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title = "Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil",
abstract = "Background: Controversy remains about the optimal treatment for blood blister-like aneurysms (BBAs). Objective: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. Methods: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. Results: Initial treatments were ≥ 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0{\%}) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4{\%}, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7{\%}, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence (P < .05). Conclusion: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment.",
author = "Lim, {Yong Cheol} and Kim, {Byung Moon} and Suh, {Sang Hyun} and Pyoung Jeon and Kim, {Sang Heum} and Ihn, {Yon Kwon} and Lee, {Young Jun} and Sim, {Sook Young} and Joonho Chung and Kim, {Dong Joon} and Kim, {Dong Ik}",
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Lim, YC, Kim, BM, Suh, SH, Jeon, P, Kim, SH, Ihn, YK, Lee, YJ, Sim, SY, Chung, J, Kim, DJ & Kim, DI 2013, 'Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil', Neurosurgery, vol. 73, no. 3, pp. 480-488. https://doi.org/10.1227/NEU.0000000000000005

Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil. / Lim, Yong Cheol; Kim, Byung Moon; Suh, Sang Hyun; Jeon, Pyoung; Kim, Sang Heum; Ihn, Yon Kwon; Lee, Young Jun; Sim, Sook Young; Chung, Joonho; Kim, Dong Joon; Kim, Dong Ik.

In: Neurosurgery, Vol. 73, No. 3, 01.09.2013, p. 480-488.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reconstructive treatment of ruptured blood blister-like aneurysms with stent and coil

AU - Lim, Yong Cheol

AU - Kim, Byung Moon

AU - Suh, Sang Hyun

AU - Jeon, Pyoung

AU - Kim, Sang Heum

AU - Ihn, Yon Kwon

AU - Lee, Young Jun

AU - Sim, Sook Young

AU - Chung, Joonho

AU - Kim, Dong Joon

AU - Kim, Dong Ik

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Background: Controversy remains about the optimal treatment for blood blister-like aneurysms (BBAs). Objective: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. Methods: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. Results: Initial treatments were ≥ 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0%) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4%, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7%, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence (P < .05). Conclusion: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment.

AB - Background: Controversy remains about the optimal treatment for blood blister-like aneurysms (BBAs). Objective: To evaluate clinical and angiographic outcomes after reconstructive treatment for BBA with stent and coil. Methods: Thirty-four patients (6 men, 28 women; mean age, 47.3 years) with ruptured BBAs underwent reconstructive treatment with stent and coil. Posttreatment courses and outcomes were retrospectively evaluated. Results: Initial treatments were ≥ 2 overlapping stents with or without coiling (n = 28) and single stent with coiling (n = 6). Three BBAs rebled on days 9, 11, and 15 after treatment, resulting in 1 death. Except for 3 patients who died early, 31 patients were followed up for 7 to 80 months (median, 32 months). One patient recovered completely but died of complications of systemic lupus erythematosus at 25 months. Of the remaining 30 patients, 25 had favorable outcomes (modified Rankin scale, 0-2) and 5 had unfavorable outcomes. Angiographic follow-up was available in the 32 BBAs. Eight (25.0%) recurred, all within 5 weeks. In the multiple stents group (n = 26), 22 BBAs showed improvement or complete healing, but 4 (15.4%, 2 rebleedings) had recurrence. In the single stent with coiling group (n = 6), 2 BBAs were stable but 4 (66.7%, 1 rebleeding) had recurrence. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence (P < .05). Conclusion: Reconstructive treatment with stent and coil appears a viable option for BBAs. Single stent with coiling and Hunt and Hess grade ≥ 4 were 2 independent risk factors for recurrence. Follow-up angiography should be considered mandatory soon after treatment.

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DO - 10.1227/NEU.0000000000000005

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