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Endovascular treatment of ruptured blood blister-like aneurysms with multiple (≥3) overlapping Enterprise stents and coiling

  • Clinical Article - Vascular
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Abstract

Background

Blood blister-like aneurysms (BBAs) are difficult to treat both surgically and endovascularly, and the optimal treatment remains controversial. The aim of this study was to evaluate the clinical and angiographic feasibility of multiple overlapping stents (≥3) with coiling for treating BBA.

Methods

A retrospective review from four institutions identified ten patients with ruptured BBAs who were treated with multiple overlapping stents (≥3). We included both the patients who were initially treated with more than three stents and those who eventually had more than three stents as a consequence of retreatment. Angiographic results (Raymond scale), clinical outcomes (mRS) and treatment courses were evaluated.

Results

Initially, seven patients were treated with triple stents and three with double stents. Immediate angiographic results revealed that six aneurysms were Raymond grade 1, three were grade 2, and one was grade 3. Complementary treatment was required in four patients. All three patients who were initially treated with double stents required complementary treatment (100 %). One patient required complementary treatment among the seven patients who were initially treated with three stents (14.3 %). The last follow-up angiography (mean, 12.2 ± 14.7 months; range, 1–44 months) revealed grade 1 in all ten patients. Clinical data (mean follow-up period, 18.2 ± 20.1 months; range, 1–62 months) revealed eight patients with a mRS score of 0–2 and two with mRS 3–5.

Conclusions

Even in the era of flow diverter stents, multiple overlapping stents (≥3) with coiling could be a feasible alternative for treating ruptured BBAs. Additional experience and follow-up are needed in a larger series to state the long-term efficacy of this treatment.

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Abbreviations

BBA:

blood blister-like aneurysm

EVT:

endovascular treatment

EVD:

external ventricular drain

SAH:

subarachnoid hemorrhage

HH:

Hunt and Hess scale

mRS:

modified Rankin Scale

PAO:

parent artery occlusion

SAC:

stent-assisted coil embolization

SOT:

stent-only therapy

FD:

flow-diverting device

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Authors and Affiliations

  1. Department of Neurosurgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea

    Jihye Song & Yong Sam Shin

  2. Department of Neurosurgery, Inha University Hospital, Inha University of Medicine, Incheon, Republic of Korea

    Seyang Oh

  3. Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Republic of Korea

    Myeong Jin Kim

  4. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Joonho Chung

  5. Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea

    Yong Cheol Lim

  6. Department of Radiology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Bum-Soo Kim

Authors
  1. Jihye Song
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  2. Seyang Oh
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  3. Myeong Jin Kim
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  4. Joonho Chung
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  5. Yong Cheol Lim
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  6. Bum-Soo Kim
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  7. Yong Sam Shin
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Corresponding author

Correspondence to Yong Sam Shin.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Funding

No funding was received for this research.

Conflict of interests

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Informed consent was obtained from all individual participants included in the study.

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Song, J., Oh, S., Kim, M.J. et al. Endovascular treatment of ruptured blood blister-like aneurysms with multiple (≥3) overlapping Enterprise stents and coiling. Acta Neurochir 158, 803–809 (2016). https://doi.org/10.1007/s00701-016-2721-8

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  • DOI: https://doi.org/10.1007/s00701-016-2721-8

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