Juergen Konczalla1, Florian Gessler2, Markus Bruder2, Joachim Berkefeld3, Gerhard Marquardt2, Volker Seifert2. 1. Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany. Electronic address: J.Konczalla@med.uni-frankfurt.de. 2. Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany. 3. Institute of Neuroradiology, Goethe-University Hospital, Frankfurt am Main, Germany.
Abstract
BACKGROUND: Blood blister-like aneurysms (BBLA) are rare, challenging to treat, and prone to rerupture. We analyzed our results in relationship to type of BBLA and other prognostic factors. METHODS: Data on patient and aneurysm characteristics, clinical course, and treatment results, including data from patient records and review of imaging findings, were collected prospectively and analyzed retrospectively. RESULTS: There were 27 patients (mean age 56 years) with subarachnoid hemorrhage from BBLA. Of patients, 13 (48%) had BBLA of the internal carotid artery, 6 had BBLA of the anterior cerebral artery (22%), 5 had BBLA of the middle cerebral artery (19%), and 3 had BBLA of the basilar artery (11%). Most patients (n = 12) had a circumferential type IV BBLA (44%). BBLAs were treated by clip-reinforced wrapping in 13 patients (48%) and by clipping alone in 8 patients (30%); 3 (11%) patients received no treatment. The 3 remaining patients were treated endovascularly, by combined treatment, or by fenestration tube technique. Rerupture after treatment occurred in 4 patients (15%), all of whom had type IV BBLAs. Outcome was unfavorable (modified Rankin scale score 3-6) in 52% (n = 14). The highest rates of rerupture (33%), delayed infarctions (67%), unfavorable outcome (75%), and death (50%) were identified in type IV BBLAs; type I-III BBLAs had a better course. CONCLUSIONS: Treatment of BBLA is challenging. Patients with type IV BBLAs were especially prone to rerupture, delayed infarctions, unfavorable outcomes, and death. Independent risk factors for unfavorable outcome were advanced age (≥60 years) and type IV BBLA.
BACKGROUND: Blood blister-like aneurysms (BBLA) are rare, challenging to treat, and prone to rerupture. We analyzed our results in relationship to type of BBLA and other prognostic factors. METHODS: Data on patient and aneurysm characteristics, clinical course, and treatment results, including data from patient records and review of imaging findings, were collected prospectively and analyzed retrospectively. RESULTS: There were 27 patients (mean age 56 years) with subarachnoid hemorrhage from BBLA. Of patients, 13 (48%) had BBLA of the internal carotid artery, 6 had BBLA of the anterior cerebral artery (22%), 5 had BBLA of the middle cerebral artery (19%), and 3 had BBLA of the basilar artery (11%). Most patients (n = 12) had a circumferential type IV BBLA (44%). BBLAs were treated by clip-reinforced wrapping in 13 patients (48%) and by clipping alone in 8 patients (30%); 3 (11%) patients received no treatment. The 3 remaining patients were treated endovascularly, by combined treatment, or by fenestration tube technique. Rerupture after treatment occurred in 4 patients (15%), all of whom had type IV BBLAs. Outcome was unfavorable (modified Rankin scale score 3-6) in 52% (n = 14). The highest rates of rerupture (33%), delayed infarctions (67%), unfavorable outcome (75%), and death (50%) were identified in type IV BBLAs; type I-III BBLAs had a better course. CONCLUSIONS: Treatment of BBLA is challenging. Patients with type IV BBLAs were especially prone to rerupture, delayed infarctions, unfavorable outcomes, and death. Independent risk factors for unfavorable outcome were advanced age (≥60 years) and type IV BBLA.
Authors: V Hellstern; M Aguilar-Pérez; M AlMatter; P Bhogal; E Henkes; O Ganslandt; H Henkes Journal: Interv Neuroradiol Date: 2018-07-12 Impact factor: 1.610