PT - JOURNAL ARTICLE AU - S. Meckel AU - T.P. Singh AU - P. Undrén AU - B. Ramgren AU - O.G. Nilsson AU - C. Phatouros AU - W. McAuliffe AU - M. Cronqvist TI - Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister–Like Aneurysms AID - 10.3174/ajnr.A2392 DP - 2011 Apr 01 TA - American Journal of Neuroradiology PG - 764--771 VI - 32 IP - 4 4099 - http://www.ajnr.org/content/32/4/764.short 4100 - http://www.ajnr.org/content/32/4/764.full SO - Am. J. Neuroradiol.2011 Apr 01; 32 AB - 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. ACTactivated clotting timeantlatanterolateralantmedanteromedialBAPballoon angioplastyBA-Tbasilar artery trunkBBAblood blister–like aneurysmC6–7ICA segmentscoil protrcoil protrusion into parent arteryCTACT angiographyDSAdigital subtraction angiographyEVTendovascular treatmentGDCGuglielmi detachable coilHHHunt and Hess scaleICAinternal carotid arteryICAPintra-arterial chemical angioplastyIVintravenousLleftLMWHlow-molecular-weight heparinmedmedialMMmedical managementMRAMR angiographymRSmodified Rankin ScaleNGTnasogastric tubelow-dose s.c.5000 IU heparin/day subcutaneouslyPAOparent artery occlusionpostposteriorpostmedposteromedialprotrprotrusionproxproximalRrightSAHsubarachnoid hemorrhaget-fibrintransient fibrin formation