RT Journal Article
SR Electronic
T1 Endovascular Treatment Using Predominantly Stent-Assisted Coil Embolization and Antiplatelet and Anticoagulation Management of Ruptured Blood Blister–Like Aneurysms
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 764
OP 771
DO 10.3174/ajnr.A2392
VO 32
IS 4
A1 S. Meckel
A1 T.P. Singh
A1 P. Undrén
A1 B. Ramgren
A1 O.G. Nilsson
A1 C. Phatouros
A1 W. McAuliffe
A1 M. Cronqvist
YR 2011
UL http://www.ajnr.org/content/32/4/764.abstract
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