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Reconstructive Treatment of Ruptured Blood Blisterlike Aneurysms With Stent and Coil

Lim, Yong Cheol MD*; Kim, Byung Moon MD; Suh, Sang Hyun MD§; Jeon, Pyoung MD; Kim, Sang Heum MD||; Ihn, Yon-Kwon MD#; Lee, Young-Jun MD**; Sim, Sook Young MD‡‡; Chung, Joonho MD§§; Kim, Dong Joon MD; Kim, Dong Ik MD

Neurosurgery:
doi: 10.1227/NEU.0000000000000005
Research-Human-Clinical Studies
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.

ABBREVIATIONS: BBA, blood blister--like aneurysm

ICA, internal carotid artery

mRS, modified Rankin Scale

SAH, subarachnoid hemorrhage

Author Information

*Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, South Korea;

Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea;

§Radiology and

§§Neurosugery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea;

Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;

||Radiology, Bundang CHA Hospital, CHA University College of Medicine, Seong-Nam, South Korea;

#Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, South Korea;

**Radiology, Hanyang University Medical Center, Seoul, South Korea;

‡‡Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea

Correspondence: Byung Moon Kim, MD, Interventional Neuroradiology, Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. E-mail: bmoon21@hanmail.net

Received January 12, 2013

Accepted May 22, 2013

Copyright © by the Congress of Neurological Surgeons