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 LopesAhmed 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

16 Scopus citations

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

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., Hanel, R., Aguilar-Salinas, P., Turk, A. S., Turner, R. D., Chaudry, M. I., Ringer, A. J., Welch, B. G., Mendes Pereira, V., Renieri, L., Piano, M., Elijovich, L., Arthur, A. S., Cheema, A., ... 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