Top

Published in:

01-02-2011 | Clinical Article

Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery

Authors: Noriaki Matsubara, Shigeru Miyachi, Nobuhiro Tsukamoto, Takashi Izumi, Takehiro Naito, Kenichi Haraguchi, Toshihiko Wakabayashi

Published in: Acta Neurochirurgica | Issue 2/2011

Abstract

Background

Because of their fragile and thin wall, ruptured blood blister-like aneurysms (BBAs) at the anterior wall of the internal carotid artery (ICA) are difficult to manage, both surgically, as well as endovascularly. BBA is usually a tiny and broad-necked aneurysm, but it occasionally demonstrates a relatively saccular-like shape. In addition, the pseudoaneurysm sac often assumes a saccular shape. In this paper, the authors present their experience in treating these saccular-shaped BBAs endovascularly with coil packing.

Method

Nine saccular-shaped ruptured BBAs in nine patients (one male and eight females; mean age 51.3 years, range 38–76) were treated with coil packing of the lesion between January 2006 and August 2010 in Nagoya University and its affiliated hospitals. Clinical, procedural, and angiographic data were retrospectively evaluated.

Findings

Seven BBAs were treated by balloon-assisted coil embolization. Two remaining BBAs were embolized without balloon inflation, though a balloon catheter was on standby at the ICA. In one case, in which a saccular coil embolization could not be achieved, ICA trapping was performed. Three (33.3%) were treated in acute, two (22.2%) in subacute, and four (44.4%) in chronic period. One (11.1%) intraoperative rupture occurred. Six (66.7%) had excellent clinical outcomes, while two (22.2%) proved fatal outcomes. During the follow-up period (mean 18.9 months, range 4–48), two out of seven (28.6%) aneurysms presented an angiographical recurrence, but both were treated by coil embolization without complications. The remaining five (71.4%) aneurysms were completely resolved.

Conclusions

Endovascular coil embolization can be considered as an alternative treatment option for selective saccular-shaped BBAs.

Ahn JY, Kwon SO, Joo JY (2001) Dorsal internal carotid artery aneurysm treated by coil embolization—case report. Neurol Med Chir (Tokyo) 41:603–605CrossRef

Başkaya MK, Ahmed AS, Ateş O, Niemann D (2008) Surgical treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery with extracranial-intracranial bypass and trapping. Neurosurg Focus 24:E13PubMed

Doorenbosch X, Harding M (2008) Primary treatment of a blood-blister-like aneurysm of the internal carotid artery with Guglielmi detachable coil embolisation. J Clin Neurosci 15:1276–1279CrossRefPubMed

Ezaki Y, Takahata H, Kamada K, Baba S, Kaminogo M (2006) Aneurysmal embolization of a blisterlike aneurysm of the internal carotid artery: a case report and review of the literature. Surg Neurol 65:628–630CrossRefPubMed

Hong B, Patel NV, Gounis MJ, DeLeo MJ 3rd, Linfante I, Wojak JC, Wakhloo AK (2009) Semi-jailing technique for coil embolization of complex, wide-necked intracranial aneurysms. Neurosurgery 65:1131–1138CrossRefPubMed

Ishikawa T, Mutoh T, Nakayama N, Yasuda H, Nomura M, Kazumata K, Moroi J, Yasui N (2009) Universal external carotid artery to proximal middle cerebral artery bypass with interposed radial artery graft prior to approaching ruptured blood blister-like aneurysm of the internal carotid artery. Neurol Med Chir (Tokyo) 49:553–558CrossRef

Ishikawa T, Nakamura N, Houkin K, Nomura M (1997) Pathological consideration of a “blister-like” aneurysm at the superior wall of the internal carotid artery: case report. Neurosurgery 40:403–405CrossRefPubMed

Kamijo K, Matsui T (2010) Acute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister–like aneurysm of the internal carotid artery. Clinical artery. J Neurosurg 113:781–785. doi:10.3171/2009.10.JNS09970 CrossRefPubMed

Kim BM, Chung EC, Park SI, Choi CS, Won YS (2007) Treatment of blood blister-like aneurysm of the internal carotid artery with stent-assisted coil embolization followed by stent-within-a-stent technique. Case report. J Neurosurg 107:1211–1213CrossRefPubMed

10.

Korja M, Rautio R, Valtonen S, Haapanen A (2008) Primary treatment of ruptured blood blister-like aneurysms with stent-assisted coil embolization: report of two cases. Acta Radiol 49:180–183CrossRefPubMed

11.

Kulcsár Z, Wetzel SG, Augsburger L, Gruber A, Wanke I, Rüfenacht DA (2010) Effect of flow diversion treatment on very small ruptured aneurysms. Neurosurgery 67:789–793CrossRefPubMed

12.

Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH, Choi CS, Won YS, Yu IK (2009) Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. J Neurosurg 110:431–436CrossRefPubMed

13.

Lee CC, Hsieh TC, Wang YC, Lo YL, Lee ST, Yang TC (2010) Ruptured symptomatic internal carotid artery dorsal wall aneurysm with rapid configurational change: clinical experience and management outcome. Eur J Neurol 17:1277–1284. doi:10.1111/j.1468-1331.2010.03029.x CrossRefPubMed

14.

McNeely PD, Clarke DB, Baxter B, Vandorpe RA, Mendez I (2002) Endovascular treatment of a “blister-like” aneurysm on the internal carotid artery. Can J Neurol Sci 27:247–250

15.

Meling TR, Sorteberg A, Bakke SJ, Slettebo H, Hernesniemi J, Sorteberg W (2008) Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg 108:662–671CrossRefPubMed

16.

Mizutani T, Kojima H, Asamoto S (2004) Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54:342–347CrossRefPubMed

17.

Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259CrossRefPubMed

18.

Ogawa A, Suzuki M, Ogasawara K (2000) Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 47:578–583CrossRefPubMed

19.

Park JH, Park IS, Han DH, Kim SH, Oh CW, Kim JE, Kim JH, Han MH, Kwon OK (2007) Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. J Neurosurg 106:812–819CrossRefPubMed

20.

Sano K (1996) Concerning the nomenclature and classification of internal carotid aneurysms. Surg Cereb Stroke 24:333–339, Jpn

21.

Satoh A, Sugiyama T, Hongo K, Kakizawa Y, Ishihara S, Matsutani M (2008) Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature. Acta Neurochir Suppl 103:51–55CrossRefPubMed

22.

Sim SY, Shin YS, Cho KG, Kim SY, Kim SH, Ahn YH, Yoon SH, Cho KH (2006) Blood blister-like aneurysms at nonbranching sites of the internal carotid artery. J Neurosurg 105:400–405CrossRefPubMed

23.

Tanoue S, Kiyosue H, Matsumoto S, Yamashita M, Nagatomi H, Mori H (2004) Ruptured “blisterlike” aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization. Case report. J Neurosurg 101:159–162CrossRefPubMed

Title: Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery
Authors: Noriaki Matsubara
Shigeru Miyachi
Nobuhiro Tsukamoto
Takashi Izumi
Takehiro Naito
Kenichi Haraguchi
Toshihiko Wakabayashi
Publication date: 01-02-2011
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2011
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-010-0898-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endovascular coil embolization for saccular-shaped blood blister-like aneurysms of the internal carotid artery

Abstract

Background

Method

Findings

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Findings

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2011

Fatal “hypertensive” intracerebral hemorrhage associated with a cerebral cavernous angioma: case report

Cerebral cavernous malformations and intractable epilepsy: the limited usefulness of current literature

Computerized angiographic evaluation of coil density and occlusion rate in embolized cerebral aneurysms

Transient oculomotor nerve palsy after topical administration of intracisternal papaverine

Radiotherapy-induced supratentorial primitive neuroectodermal tumour in a 17-year-old female: a case report and review of the literature

Endovascular treatment of high-flow cervical direct vertebro-vertebral arteriovenous fistula with detachable coils and Onyx liquid embolic agent