Skip Navigation LinksHome > September 2013 - Volume 73 - Issue 3 > Reconstructive Treatment of Ruptured Blood Blister–like Aneu...
Neurosurgery:
doi: 10.1227/NEU.0000000000000005
Research-Human-Clinical Studies

Reconstructive Treatment of Ruptured Blood Blister–like 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

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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

Copyright © by the Congress of Neurological Surgeons

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