Treatment of blood blister aneurysms of the internal carotid artery with flow diversion

Maxim Mokin, Angel Chinea, Christopher T. Primiani, Zeguang Ren, Peter Kan, Visish M. Srinivasan, Ricardo Hanel, Pedro Aguilar-Salinas, Aquilla S. Turk, Raymond D. Turner, M. Imran Chaudry, Andrew J. Ringer, Babu G. Welch, Vitor Mendes Pereira, Leonardo Renieri, Mariangela Piano, Lucas Elijovich, Adam S. Arthur, Ahmed Cheema, Demetrius Klee Lopes & 10 others Ahmed Saied, Blaise W. Baxter, Harris Hawk, Ajit S. Puri, Ajay K. Wakhloo, Hussain Shallwani, Elad I. Levy, Adnan H. Siddiqui, Guilherme Dabus, Italo Linfante

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. Objective: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). Methods: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis. Results: 49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68% of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0-2) at 3 months. There were 7 (16%) immediate procedural and 2 (5%) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment. Conclusions: Our data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.

Original languageEnglish (US)
JournalJournal of NeuroInterventional Surgery
DOIs
StateAccepted/In press - Feb 24 2018

Fingerprint

Internal Carotid Artery
Blister
Aneurysm
Therapeutics
Equipment and Supplies
Intracranial Aneurysm
Rupture

Keywords

  • aneurysm
  • flow diverter
  • subarachnoid

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Mokin, M., Chinea, A., Primiani, C. T., Ren, Z., Kan, P., Srinivasan, V. M., ... Linfante, I. (Accepted/In press). Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. Journal of NeuroInterventional Surgery. https://doi.org/10.1136/neurintsurg-2017-013701

Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. / Mokin, Maxim; Chinea, Angel; Primiani, Christopher T.; Ren, Zeguang; Kan, Peter; Srinivasan, Visish M.; Hanel, Ricardo; Aguilar-Salinas, Pedro; Turk, Aquilla S.; Turner, Raymond D.; Chaudry, M. Imran; Ringer, Andrew J.; Welch, Babu G.; Mendes Pereira, Vitor; Renieri, Leonardo; Piano, Mariangela; Elijovich, Lucas; Arthur, Adam S.; Cheema, Ahmed; Lopes, Demetrius Klee; Saied, Ahmed; Baxter, Blaise W.; Hawk, Harris; Puri, Ajit S.; Wakhloo, Ajay K.; Shallwani, Hussain; Levy, Elad I.; Siddiqui, Adnan H.; Dabus, Guilherme; Linfante, Italo.

In: Journal of NeuroInterventional Surgery, 24.02.2018.

Research output: Contribution to journalArticle

Mokin, M, Chinea, A, Primiani, CT, Ren, Z, Kan, P, Srinivasan, VM, Hanel, R, Aguilar-Salinas, P, Turk, AS, Turner, RD, Chaudry, MI, Ringer, AJ, Welch, BG, Mendes Pereira, V, Renieri, L, Piano, M, Elijovich, L, Arthur, AS, Cheema, A, Lopes, DK, Saied, A, Baxter, BW, Hawk, H, Puri, AS, Wakhloo, AK, Shallwani, H, Levy, EI, Siddiqui, AH, Dabus, G & Linfante, I 2018, 'Treatment of blood blister aneurysms of the internal carotid artery with flow diversion', Journal of NeuroInterventional Surgery. https://doi.org/10.1136/neurintsurg-2017-013701
Mokin, Maxim ; Chinea, Angel ; Primiani, Christopher T. ; Ren, Zeguang ; Kan, Peter ; Srinivasan, Visish M. ; Hanel, Ricardo ; Aguilar-Salinas, Pedro ; Turk, Aquilla S. ; Turner, Raymond D. ; Chaudry, M. Imran ; Ringer, Andrew J. ; Welch, Babu G. ; Mendes Pereira, Vitor ; Renieri, Leonardo ; Piano, Mariangela ; Elijovich, Lucas ; Arthur, Adam S. ; Cheema, Ahmed ; Lopes, Demetrius Klee ; Saied, Ahmed ; Baxter, Blaise W. ; Hawk, Harris ; Puri, Ajit S. ; Wakhloo, Ajay K. ; Shallwani, Hussain ; Levy, Elad I. ; Siddiqui, Adnan H. ; Dabus, Guilherme ; Linfante, Italo. / Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. In: Journal of NeuroInterventional Surgery. 2018.
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abstract = "Background: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. Objective: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). Methods: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis. Results: 49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5{\%} of aneurysms (28/32) showed complete obliteration, 9.4{\%} (3/32) showed reduced filling, and 3.1{\%} (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68{\%} of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0-2) at 3 months. There were 7 (16{\%}) immediate procedural and 2 (5{\%}) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment. Conclusions: Our data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.",
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T1 - Treatment of blood blister aneurysms of the internal carotid artery with flow diversion

AU - Mokin, Maxim

AU - Chinea, Angel

AU - Primiani, Christopher T.

AU - Ren, Zeguang

AU - Kan, Peter

AU - Srinivasan, Visish M.

AU - Hanel, Ricardo

AU - Aguilar-Salinas, Pedro

AU - Turk, Aquilla S.

AU - Turner, Raymond D.

AU - Chaudry, M. Imran

AU - Ringer, Andrew J.

AU - Welch, Babu G.

AU - Mendes Pereira, Vitor

AU - Renieri, Leonardo

AU - Piano, Mariangela

AU - Elijovich, Lucas

AU - Arthur, Adam S.

AU - Cheema, Ahmed

AU - Lopes, Demetrius Klee

AU - Saied, Ahmed

AU - Baxter, Blaise W.

AU - Hawk, Harris

AU - Puri, Ajit S.

AU - Wakhloo, Ajay K.

AU - Shallwani, Hussain

AU - Levy, Elad I.

AU - Siddiqui, Adnan H.

AU - Dabus, Guilherme

AU - Linfante, Italo

PY - 2018/2/24

Y1 - 2018/2/24

N2 - Background: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. Objective: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). Methods: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis. Results: 49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68% of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0-2) at 3 months. There were 7 (16%) immediate procedural and 2 (5%) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment. Conclusions: Our data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.

AB - Background: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. Objective: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). Methods: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis. Results: 49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68% of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0-2) at 3 months. There were 7 (16%) immediate procedural and 2 (5%) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment. Conclusions: Our data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.

KW - aneurysm

KW - flow diverter

KW - subarachnoid

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