Yibin Fang1, Deyuan Zhu2, Ya Peng3, Ming Zhong4, Jing Xu5, Qiuping Li6, Guobiao Liang7, Yang Wang8, Wenfeng Feng9, Donghai Wang10, Yang Zhang11, Dong Chen12, Qingdong Guo13, Tianxiao Li14, Xiaodong Xie15, Gang Zhu16, Sheng Guan17, Zhen Gu18, Gang Li19, Hua Yang20, Xueyang He21, Qin Zhu22, Jieqing Wan23, Qiang Li1, Pengfei Yang1, Rui Zhao1, Qianghai Huang1, Bo Hong1, Yi Xu1, Jianmin Liu24. 1. Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China. 2. Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China; Department of Neurosurgery, The 71st Group Army Hospital of CPLA Army (Affiliated Huaihai Hospital of Xuzhou Medical University), Xuzhou, China. 3. Cerebral Vascular Disease Center, The First People's Hospital of Changzhou, Soochow University, Changzhou, China. 4. Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 5. Department of Neurological Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. 6. Department of Neurosurgery, Zhongshan Hospital of Fudan University, Shanghai, China. 7. Department of Neurosurgery, The General Hospital of Shenyang Military Command, Shenyang, China. 8. Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China. 9. Nanfang Glioma Center, Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China. 10. Department of Neurosurgery, Qilu Hospital of Shandong University, Shandong, China. 11. Department of Neurosurgery, Anhui Provincial Hospital, Anhui, China. 12. Department of Neurosurgery, Shenzhen People's Hospital, Guangdong, China. 13. Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China. 14. Department of Cerebrovascular Disease, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China. 15. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China. 16. Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China. 17. Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 18. Department of Neurosurgery, Fourth Hospital of Kunming Medical University, Yunnan, China. 19. Department of Cerebrovascular Disease, The First Affiliated Hospital of Zunyi Medical College, Guizhou, China. 20. Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China. 21. Department of Neurosurgery, Quanzhou First Hospital, Fujian, China. 22. Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, China. 23. Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. 24. Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China. Electronic address: chstroke@163.com.
Abstract
OBJECTIVE: To clarify safety and efficacy of stent-assisted coiling for treatment of blood blister-like aneurysm (BBA) in a multicenter experience. METHODS: A total of 212 consecutive cases (213 BBAs) treated with stent-assisted coiling were retrospectively reviewed and included in the final analysis. Outcomes including complete occlusion, recurrence, perioperative morbidity and mortality, and overall good neurologic outcome during follow-up were analyzed. RESULTS: Of 212 patients, 102 (48.1%) were treated with a single stent, 77 (36.3%) were treated with 2 stents, and 33 (15.6%) were treated with ≥3 stents. Angiographic follow-up data were available for 96 BBAs; 64.6% of BBAs showed complete obliteration, and 22.9% showed recurrence. Complete obliteration rates of patients treated with single, 2, and ≥3 stents were 42.9%, 78.4%, and 88.2%. Recurrence rates of patients treated with single, 2, and ≥3 stents were 38.1%, 13.5%, and 5.9%. Using ≥2 stents seemed to result in higher obliteration rates (P < 0.001) and lower recurrence rates (P = 0.002). Clinical follow-up data available for 180 patients showed 91.1% of patients had a good clinical outcome. No difference was found between the 3 stent treatments. There were 14 (6.6%) perioperative ischemic complications and 12 (5.7%) hemorrhagic complications, with 10 (4.7%) cases of perioperative deaths. Using ≥2 stents seemed to result in a lower perioperative hemorrhagic complication rate compared with single stent (P = 0.037). CONCLUSIONS: Our data support the use of overlapping (≥2) stents combined with coiling as a safe and effective therapeutic modality for BBA. Overlapping (≥2) stents may provide higher obliteration rate, lower recurrence rate, and lower perioperative hemorrhagic risk in treatment of BBA.
OBJECTIVE: To clarify safety and efficacy of stent-assisted coiling for treatment of blood blister-like aneurysm (BBA) in a multicenter experience. METHODS: A total of 212 consecutive cases (213 BBAs) treated with stent-assisted coiling were retrospectively reviewed and included in the final analysis. Outcomes including complete occlusion, recurrence, perioperative morbidity and mortality, and overall good neurologic outcome during follow-up were analyzed. RESULTS: Of 212 patients, 102 (48.1%) were treated with a single stent, 77 (36.3%) were treated with 2 stents, and 33 (15.6%) were treated with ≥3 stents. Angiographic follow-up data were available for 96 BBAs; 64.6% of BBAs showed complete obliteration, and 22.9% showed recurrence. Complete obliteration rates of patients treated with single, 2, and ≥3 stents were 42.9%, 78.4%, and 88.2%. Recurrence rates of patients treated with single, 2, and ≥3 stents were 38.1%, 13.5%, and 5.9%. Using ≥2 stents seemed to result in higher obliteration rates (P < 0.001) and lower recurrence rates (P = 0.002). Clinical follow-up data available for 180 patients showed 91.1% of patients had a good clinical outcome. No difference was found between the 3 stent treatments. There were 14 (6.6%) perioperative ischemic complications and 12 (5.7%) hemorrhagic complications, with 10 (4.7%) cases of perioperative deaths. Using ≥2 stents seemed to result in a lower perioperative hemorrhagic complication rate compared with single stent (P = 0.037). CONCLUSIONS: Our data support the use of overlapping (≥2) stents combined with coiling as a safe and effective therapeutic modality for BBA. Overlapping (≥2) stents may provide higher obliteration rate, lower recurrence rate, and lower perioperative hemorrhagic risk in treatment of BBA.
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