Forward deployed coil embolization with multiple overlapping stents for ruptured blood blister-like aneurysms: technical considerations and outcomes
- Authors
- Kim, Myeong Jin; Chung, Joonho; Shin, Yong Sam; Lim, Yong Cheol
- Issue Date
- 3-Jun-2019
- Publisher
- TAYLOR & FRANCIS LTD
- Keywords
- Blood blister-like aneurysm; stent-assisted coiling; multiple overlapping stents; subarachnoid hemorrhage
- Citation
- NEUROLOGICAL RESEARCH, v.41, no.6, pp.562 - 568
- Journal Title
- NEUROLOGICAL RESEARCH
- Volume
- 41
- Number
- 6
- Start Page
- 562
- End Page
- 568
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/1345
- DOI
- 10.1080/01616412.2019.1584424
- ISSN
- 0161-6412
- Abstract
- Background: Coil embolization with multiple overlapping stents was performed as an alternative treatment option for blood blister-like aneurysms (BBAs). However, coil placement into the BBAs has the inherent risks of rupture and regrowth. We describe a safe dense coil packing technique into and just proximal of BBAs using a semi-jailing technique for the treatment of BBAs of the internal carotid artery (ICA) and report the long-term clinical outcomes. Methods: The technique involves the partial deployment of a self-expanding and retrievable stent from the ICA bifurcation to the mid-portion of a BBA followed by coil embolization with gradual unsheathing of the stent from the BBA to its just proximal portion. Seventeen patients were treated using this technique (10 women; mean age, 47.9 +/- 11 years; overall mean clinical follow-up period, 42.3 +/- 22.8 months). Technique safety and feasibility, and follow-up angiographic results and clinical outcomes (modified Rankin Scale, mRS) were evaluated. Results: Procedures were successfully applied without any procedure-related complications. Immediate post-treatment angiograms showed total obliteration of the BBAs in all 17 patients. Follow-up angiograms, which were available in 15 (88.2%) patients, showed complete resolution of BBAs. Fourteen (82.4%) of 17 patients achieved favorable clinical outcomes (mRS <= 2). Conclusions: Forward deployed coil embolization with multiple overlapping stents offers a safe and effective reconstructive endovascular technique for the treatment of the BBAs.
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