Abstract
BACKGROUND AND PURPOSE: BBA is a rare type of intracranial aneurysm that is difficult to treat both surgically and endovascularly and is often associated with a high degree of morbidity/mortality. The aim of this study was to present clinical and angiographic results, as well as antiplatelet/anticoagulation regimens, of endovascular BBA treatment by using predominantly stent-assisted coil embolization.
MATERIALS AND METHODS: Thirteen patients (men/women, 6/7; mean age, 49.3 years) with ruptured BBAs were included from 2 different institutions. Angiographic findings, treatment strategies, anticoagulation/antiplatelet protocols, and clinical (mRS) and angiographic outcome were retrospectively analyzed.
RESULTS: Eleven BBAs were located in the supraclinoid ICA, and 2 on the basilar artery trunk. Nine of 13 were ≤3 mm in the largest diameter, and 8/13 showed early growth before treatment. Primary stent-assisted coiling was performed in 11/13 patients, double stents and PAO in 1 patient, each. Early complementary treatment was required in 3 patients, including PAO in 2. In stent-placement procedures, altered periprocedural antiplatelet (11/12) and postprocedural heparin (6/12) protocols were used without evidence of thromboembolic events. Two patients had early rehemorrhage, including 1 major fatal SAH. Twelve of 13 BBAs showed complete or progressive occlusion at late angiographic follow-up. Clinical midterm outcome was good (mRS scores, 0–2) in 12/13 patients.
CONCLUSIONS: Stent-assisted coiling of ruptured BBAs is technically challenging but can be done with good midterm results. Reduced periprocedural and postprocedural antiplatelet/anticoagulation protocols may be used with a low reasonable risk of thromboembolic complications. However, regrowth/rerupture remains a problem underlining the importance of early angiographic follow-up and re-treatment, including PAO if necessary.
Footnotes
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- ACT
- activated clotting time
- antlat
- anterolateral
- antmed
- anteromedial
- BAP
- balloon angioplasty
- BA-T
- basilar artery trunk
- BBA
- blood blister–like aneurysm
- C6–7
- ICA segments
- coil protr
- coil protrusion into parent artery
- CTA
- CT angiography
- DSA
- digital subtraction angiography
- EVT
- endovascular treatment
- GDC
- Guglielmi detachable coil
- HH
- Hunt and Hess scale
- ICA
- internal carotid artery
- ICAP
- intra-arterial chemical angioplasty
- IV
- intravenous
- L
- left
- LMWH
- low-molecular-weight heparin
- med
- medial
- MM
- medical management
- MRA
- MR angiography
- mRS
- modified Rankin Scale
- NGT
- nasogastric tube
- low-dose s.c.
- 5000 IU heparin/day subcutaneously
- PAO
- parent artery occlusion
- post
- posterior
- postmed
- posteromedial
- protr
- protrusion
- prox
- proximal
- R
- right
- SAH
- subarachnoid hemorrhage
- t-fibrin
- transient fibrin formation
- © 2011 American Society of Neuroradiology