Yanming Ren1, Lunxin Liu1, Hong Sun1, Yi Liu1, Hao Li1, Lu Ma1, Chang-Wei Zhang1, Xiao-Dong Xie1, Min He1, Chao You2, Jin Li3. 1. Department of Neurosurgery, West China Hospital, Chengdu, China. 2. Department of Neurosurgery, West China Hospital, Chengdu, China. Electronic address: youchaowestchina@126.com. 3. Department of Neurosurgery, West China Hospital, Chengdu, China. Electronic address: lijinwestchina@126.com.
Abstract
BACKGROUND: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy. OBJECTIVE: To review our experience with the treatment of BBAs and explore the optimal treatment strategy. METHODS: A total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed. RESULTS: The cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year. CONCLUSIONS: BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.
BACKGROUND: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy. OBJECTIVE: To review our experience with the treatment of BBAs and explore the optimal treatment strategy. METHODS: A total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed. RESULTS: The cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year. CONCLUSIONS: BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.
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
Authors: A Scerrati; J Visani; M E Flacco; L Ricciardi; S Trungu; A Raco; F Dones; P De Bonis; C L Sturiale Journal: AJNR Am J Neuroradiol Date: 2020-12-24 Impact factor: 3.825